diabetes mellitus

d instruct the child to administer four to six injections about 2.5 cm apart before switching to another site.

a nurse is teaching a school-age child who has diabetes mellitus about insulin administration. which of the following should the nurse include in the teaching? a) "you should inject the needle at a 30-degree angle." b) "you should combine your glargine and regular insulin in the same syringe." c) "you should aspirate for blood before injecting the insulin." d) "you should give four to six injections on one area before switching sites."

b, d, e hunger, sweating, and pallor are manifestations of hypoglycemia because of the increased adrenergic nervous system activity. irritability is a manifestation of hypoglycemia because of the depleted glucose in the CNS.

a nurse is teaching an adolescent who has diabetes mellitus about manifestations of hypoglycemia. which of the following findings should the nurse include in the teaching? (select all that apply.) a) increased urination b) hunger c) poor skin turgor d) irritability e) sweating and pallor f) kussmaul respirations

complications hyperglycemic hyperosmolar syndrome

-hyperosmolar hyperglycemia is caused by a lack of sufficient insulin; ketosis is minimal or absent -hyperglycemia causes osmotic diuresis, loss of water and electrolytes, hypernatremia, and increased osmolarity -manifestations include hypotension, profound dehydration, tachycardia, and variable neurologic signs caused by cerebral dehydration -high mortality rate

type 1 diabetes

-insulin-producing beta cells in the pancreas are destroyed by an autoimmune process -requires insulin because little or no insulin is produced -onset is acute and usually before 30 years of age

hypoglycemia

-tachycardia -irritability -restless -excessive hunger -diaphoresis -depression

c regular insulin has a peak effect around 1 to 5 hr following administration.

a nurse is teaching a client about the use of insulin to treat type 1 diabetes mellitus. for which of the following types of insulin should the nurse tell the clients to expect a peak effect 1 to 5 hours after administration? a) insulin glargine b) NPH insulin c) regular insulin d) insulin lispro

2, 3, 5 shakiness, palpitations, and lightheadedness are signs/symptoms of hypoglycemia and would indicate the need for fruit or glucose. polyuria, blurred vision, and a fruity breath odor are manifestations of hyperglycemia.

the nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. the client demonstrates an understanding of the teaching by stating that a form of glucose should be taken if which symptoms develop? select all that apply. 1) polyuria 2) shakiness 3) palpitations 4) blurred vision 5) lightheadedness 6) fruity breath odor

roles of the nurse

-be knowledgeable about dietary management -communicate important information to the dietician or other management specialists -reinforce patient understanding -support dietary and lifestyle changes

type 2 diabetes

-decreased sensitivity to insulin and impaired beta cell function result in decreased insulin production -onset over age 30 years, increasing in children, obesity -slow, progressive glucose intolerance

d acarbose can cause liver toxicity when taken long-term. ensure the client's liver function is monitored while taking this medication.

a nurse is caring for a client who has been taking acarbose for type 2 diabetes mellitus. which of the following laboratory tests should the nurse plan to monitor? a) WBC b) amylase c) platelet count d) liver function tests

b the client has manifestations of hypoglycemia. offer the client 15 to 20 g of carbohydrate, such as 120 mL juice.

a nurse is caring for a client who has diabetes mellitus and reports feeling shaky and weak. the client's blood glucose is 53 mg/dL. which of the following actions should the nurse take? a) provide subcutaneous insulin for the client. b) offer the client 120 mL fruit juice. c) give the client IV potassium. d) administer IV sodium bicarbonate.

a somnolence can indicate lactic acidosis, which is manifested by extreme drowsiness, hyperventilation, and muscle pain. it is a rare but very serious adverse effect caused by metformin and should be reported to the provider.

a nurse is providing teaching for a client who has a new prescription for metformin. which of the following findings should the nurse instruct the client to report as an adverse effect of metformin? a) somnolence b) constipation c) fluid retention d) weight gain

b, e aspartame and sucralose are artificial sweeteners that can sweeten foods and beverages without adding calories.

a nurse is talking with a client who has a new diagnosis of diabetes mellitus type 2 and their caregiver. which of the following sweeteners should the nurse include as a zero-calorie sweetener option? (select all that apply.) a) sucrose b) aspartame c) mannitol d) xylitol e) sucralose

2, 3, 5 when alcohol is combined with glimepiride, a disulfiram-like reaction may occur. this syndrome includes flushing, palpitations, and nausea. alcohol can also potentiate the hypoglycemic effects of the medication. clients need to be instructed to avoid alcohol consumption while taking this medication. low-calorie desserts should also be avoided. even though the calorie content may be low, carbohydrate content is most likely high and can affect the blood glucose.

glimepiride is prescribed for a client with diabetes mellitus. the nurse instructs the client that which food items are most acceptable to consume while taking this medication? select all that apply. 1) alcohol 2) red meats 3) whole-grain cereals 4) low-calorie desserts 5) carbonated beverages

b a client who has hypoglycemia can have diaphoresis and cool, clammy skin.

a nurse is assessing a client who has hypoglycemia. which of the following findings should the nurse expect? a) fruity breath odor b) diaphoresis c) ketones in urine d) polyuria

1, 2, 3, 4 repaglinide, a rapid-acting oral hypoglycemic agent that stimulates pancreatic insulin secretion, should be taken before meals and should be withheld if the client does not eat. hypoglycemia is a side effect of repaglinide and the client should always be prepared by carrying a simple sugar at all times. metformin is an oral hypoglycemic given in combination with repaglinide and works by decreasing hepatic glucose production. a common side effect of metformin is diarrhea. muscle pain may occur as an adverse effect from metformin, but it might signify a more serious condition that warrants primary health care provider notification, not the use of acetaminophen.

the home health care nurse is visiting a client who was recently diagnosed with type 2 diabetes mellitus. the client is prescribed repaglinide and metformin. the nurse should provide which instructions to the client? select all that apply. 1) diarrhea may occur secondary to the metformin. 2) the repaglinide is not taken if a meal is skipped. 3) the repaglinide is taken 30 minutes before eating. 4) a simple sugar food item is carried and used to treat mild hypoglycemia episodes. 5) muscle pain is an expected side effect of metformin and may be treated with acetaminophen. 6) metformin increases hepatic glucose production to prevent hypoglycemia associated with repaglinide.

classifications of diabetes

-type 1 diabetes -type 2 diabetes -prediabetes, impaired glucose tolerance or impaired fasting glucose -gestational diabetes -diabetes associated with other conditions or syndromes

2 prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements.

a client with diabetes mellitus visits a health care clinic. the client's diabetes mellitus previously had been well controlled with glyburide daily, but recently the fasting blood glucose level has been 180 to 200 mg/dL. which medication, if added to the client's regimen, may have contributed to the hyperglycemia? 1) atenolol 2) prednisone 3) phenelzine 4) allopurinol

2 pramlintide is used for clients with types 1 and 2 diabetes mellitus who use insulin. it is administered subcutaneously before meals to lower blood glucose level after meals, leading to less fluctuation during the day and better long-term glucose control. because pramlintide delays gastric emptying, any prescribed oral medications should be taken 1 hour before or 2 hours after an injection of pramlintide; therefore, instructing the client to take his or her pills 1 hour before or 2 hours after the injection is correct. pramlintide should not be taken at the same time as other medications. pramlintide is given immediately before the meal in order to control postprandial rise in blood glucose, not necessarily to prevent stomach upset. it is incorrect to instruct the client to take the medication after eating, as it will not achieve its full therapeutic effect.

the nurse is providing instructions to the client newly diagnosed with diabetes mellitus who has been prescribed pramlintide. which instruction should the nurse include in the discharge teaching? 1) "inject the pramlintide at the same time you take your other medications." 2) "take your prescribed pills 1 hour before or 2 hours after the injection." 3) "be sure to take the pramlintide with food so you don't upset your stomach." 4) "make sure you take your pramlintide immediately after you eat so you don't experience a low blood sugar."

1 when preparing a mixture of short-acting insulin, such as regular insulin, with another insulin preparation, the short-acting insulin is drawn into the syringe first. this sequence will avoid contaminating the vial of the short-acting insulin with insulin of another type.

the nurse is teaching a client with diabetes mellitus how to mix regular insulin and NPH insulin 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 the NPH insulin vial first 4) injects an amount of air equal to the desired dose of insulin into each vial

c to avoid extra carbohydrate intake, the client should eat fruit that was canned with water or juice rather than syrup, honey, or molasses.

a nurse is teaching a group of clients who have diabetes about meal planning. which of the following client statements indicates understanding? a) "i will avoid having snacks." b) "i should not eat anything containing sugar." c) "i will not eat fruit canned in syrup." d) "i will not eat more than 2,800 mg of sodium a day."

3 emergency management of DKA focuses on correcting fluid and electrolyte imbalances and normalizing the serum glucose level. if the corrections occur too quickly, serious consequences, including hypoglycemia and cerebral edema, can occur. during management of DKA, when the blood glucose level falls to 250 to 300 mg/dL, the IV infusion rate is reduced and a dextrose solution is added to maintain a blood glucose of about 250 mg/dL, or until the client recovers from ketosis. fifty percent dextrose is used to treat hypoglycemia. NPH insulin is not used to treat DKA. phenytoin is not a usual treatment measure for DKA.

a client is admitted to a hospital with a diagnosis of diabetic ketoacidosis. the initial blood glucose level is 950 mg/dL. a continuous intravenous infusion of short-acting insulin is initiated, along with IV rehydration with normal saline. the serum glucose level is now decreased to 240 mg/dL. the nurse would next prepare to administer which medication? 1) an ampule of 50% dextrose 2) NPH insulin subcutaneously 3) IV fluids containing dextrose 4) phenytoin for the prevention of seizures

2 insulin in unopened vials should be stored under refrigeration until needed. vials should not be frozen. when stored unopened under refrigeration, insulin can be used up to the expiration date on the vial.

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.

3 metformin is classified as a biguanide and is the most commonly used medication for type 2 diabetes mellitus initially. it is also often used as a preventative medication for those at high risk for developing diabetes mellitus. when used alone, metformin lowers the blood glucose after meal intake as well as fasting blood glucose levels. metformin does not stimulate release and therefore poses little risk for hypoglycemia. for this reason, metformin is well suited for clients who skip meals. unusual somnolence as well as hyperventilation, myalgia, and malaise are early signs of lactic acidosis, a toxic effect associated with metformin. if any of these signs or symptoms occur, the client should inform the primary health care provider immediately. while it is best to avoid consumption of alcohol, it is not always realistic or feasible for clients to quit drinking altogether; for this reason, clients should be informed that excessive alcohol intake can cause an adverse reaction with metformin.

the nurse is providing discharge teaching for a client newly diagnosed with type 2 diabetes mellitus who has been prescribed metformin. which client statement indicates the need for further teaching? 1) "it is okay to skip meals once in a while." 2) "i need to let my doctor know if i get unusually tired." 3) "i need to constantly watch for signs of low blood sugar." 4) "i will be sure not to drink alcohol excessively while on this medication."

4 during illness, the client with type 1 diabetes mellitus is at increased risk of diabetic ketoacidosis, due to hyperglycemia associated with the stress response and due to a typically decreased caloric intake. as part of sick day management, the client with diabetes should monitor blood glucose levels and should notify the PHCP if the level is higher than 250 mg/dL. insulin should never be stopped. in fact, insulin may need to be increased during times of illness. doses should not be adjusted without the PHCP's advice and are usually adjusted on the basis of blood glucose levels, not urinary glucose readings.

the nurse provides instructions to a client newly diagnosed with type 1 diabetes mellitus. the nurse recognized accurate understanding of measures to prevent diabetic ketoacidosis when the client makes which statement? 1) "i will stop taking my insulin if i am too sick to eat." 2) "i will decrease my insulin dose during times of illness." 3) "i will adjust my insulin dose according to the level of glucose in my urine." 4) "i will notify my primary health care provider if my blood glucose level is higher than 250 mg/dL."

diabetic ketoacidosis

-onset over 4-10 hours -history (lack of insulin, febrile illness, GI upset) -breath smells like juicy fruit gum -kussmaul respirations -thirsty, dehydration -tachycardia -hypotension -acidosis -high blood sugar -hyperkalemia -ployuria -needs (hydration, insulin, electrolyte replacement)

c, d, e children who have diabetic ketoacidosis experience osmotic diuresis and mental confusion because of the electrolyte shift, and fruity breath because of the body's attempt to eliminate ketones.

a nurse is caring for a child who has type 1 diabetes mellitus. which of the following are manifestations of diabetic ketoacidosis? (select all that apply.) a) blood glucose 58 mg/dL b) weight gain c) dehydration d) mental confusion e) fruity breath

2 exercise is an important part of diabetes management. it promotes weight loss, decreases insulin resistance, and helps control blood glucose levels. a hypoglycemic reaction may occur in response to increased exercise, so clients should exercise either an hour after mealtime or after consuming a 10- to 15-g carbohydrate snack, and they should check their blood glucose level before exercising.

a client with type 1 diabetes mellitus who takes NPH daily in the morning calls the nurse to report recurrent episodes of hypoglycemia with exercising. which statement by the client indicates an adequate understanding of the peak action of NPH insulin and exercise? 1) "i should not exercise since i am taking insulin." 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) "NPH is a basal insulin, so i should exercise in the evening."

3 the primary goal of treatment in hyperosmolar hyperglycemic syndrome is to rehydrate the client to restore fluid volume and to correct electrolyte deficiency. intravenous fluid replacement is similar to that administered in ketoacidosis and begins with IV infusion of normal saline. regular insulin, not NPH insulin, would be administered. the use of sodium bicarbonate to correct acidosis is avoided because it can precipitate a further drop in serum potassium levels. intubation and mechanical ventilation are not required to treat HHS.

a client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperosmolar hyperglycemic syndrome is made. the nurse would immediately prepare to initiate which anticipated primary health care provider's prescription? 1) endotracheal intubation 2) 100 units of NPH insulin 3) intravenous infusion of normal saline 4) intravenous infusion of sodium bicarbonate

2, 3, 5 because of the profound deficiency of insulin associated with DKA, glucose cannot be used for energy and the body breaks down fat as a secondary source of energy. ketones, which are acid by-products of fat metabolism, build up, and the client experiences a metabolic ketoacidosis. high serum glucose contributes to an osmotic diuresis and the client becomes severely dehydrated. if untreated, the client will become comatose due to severe dehydration, acidosis, and electrolyte imbalance. kussmaul's respirations, the deep rapid breathing associated with DKA, is a compensatory mechanism by the body. the body attempts to correct the acidotic state by blowing off carbon dioxide, which is an acid. in the absence of insulin, the client will experience severe hyperglycemia.

a client with a diagnosis of diabetic ketoacidosis is being treated in the emergency department. which findings support this diagnosis? select all that apply. 1) increase in pH 2) comatose state 3) deep, rapid breathing 4) decreased urine output 5) elevated blood glucose level

2 anxiety is a subjective feeling of apprehension, uneasiness, or dread. the appropriate intervention is to address the client's feelings related to the anxiety. administering a sedative is not the most appropriate intervention and does not address the source of the client's anxiety. the nurse should not ignore the client's anxious feelings. anxiety needs to be managed before meaningful client education can occur.

a client with diabetes mellitus demonstrates acute anxiety when admitted to the hospital for treatment of hyperglycemia. what is the appropriate intervention to decrease the client's anxiety? 1) administer a sedative. 2) convey empathy, trust, and respect toward the client. 3) ignore the signs and symptoms of anxiety, anticipating that they will soon disappear. 4) make sure that the client is familiar with the correct medical terms to promote understanding of what is happening.

1, 3 humulin NPH is an intermediate-acting insulin. the onset of action is 60 to 120 minutes, it peaks in 6 to 14 hours, and its duration of action is 16 to 24 hours. regular insulin is a short-acting insulin. depending on the type, the onset of action is 30 to 60 minutes, it peaks in 1 to 5 hours, and its duration is 6 to 10 hours. hypoglycemic reactions most likely occur during peak time. insulin should be at room temperature when administered. clients may need their insulin dosages increased during times of illness. insulin vials should never be shaken vigorously. regular insulin is always drawn up before NPH.

a client with diabetes mellitus 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.

d, e pramlintide can cause hypoglycemia, especially when the client also takes insulin, so it is important to eat a meal after injecting this medication. unused medication in the open pramlintide vial should be discarded after 28 days.

a nurse is providing teaching to a client who has a prescription for pramlintide for type 1 diabetes mellitus. which of the following should the nurse include in the teaching? (select all that apply.) a) "take oral medications 30 min before injection." b) "use upper arms as preferred injection sites." c) "mix pramlintide with the breakfast dose of insulin." d) "inject pramlintide just before a meal." e) "discard open vials after 28 days."

b repaglinide causes a rapid, short-lived release of insulin. the client should take this medication within 30 min before each meal so that insulin is available when food is digested.

a nurse is providing teaching to a client who has type 2 diabetes mellitus and is starting repaglinide. which of the following statements by the client indicates understanding of the administration of this medication? a) "i'll take this medication after i eat." b) "i'll take this medication 30 minutes before i eat." c) "i'll take this medication just before i go to bed." d) "i'll take this medication at least 1 hour before i eat."

a, c, d, e carbohydrates should be 45% to 65% of total daily calorie intake. the client can use table sugar as long as adequate insulin or other agents are provided to cover the sugar intake. the client should count the carbohydrates in the sucrose in the daily carbohydrate count. the client can drink alcohol but should eat something to reduce the risk of hypoglycemia. the client can exchange carbohydrates as long as the total grams of carbohydrates remains the same each day.

a nurse is reinforcing dietary teaching to a client who has type 2 diabetes mellitus. which of the following instructions should the nurse include? (select all that apply.) a) "carbohydrates should comprise 55% of daily caloric intake." b) "use hydrogenated oils for cooking." c) "you can add table sugar to cereals." d) "eat something if you choose to drink alcohol." e) "use the same portion sizes to exchange carbohydrates."

a, d, e a child who is experiencing illness can have waning blood glucose levels. frequent monitoring of blood glucose levels is done to identify hyperglycemic or hypoglycemic episodes. a child who is experiencing an illness should test her urine ketones to assist in early detection of ketoacidosis and notify the provider of blood glucose levels greater than 240 mg/dL to obtain further instructions in caring for the hyperglycemia.

a nurse is reviewing sick-day management with a parent of a child who has type 1 diabetes mellitus. which of the following should the nurse include in the teaching? (select all that apply.) a) monitor blood glucose levels every 3 hr. b) discontinue taking insulin until feeling better. c) drink 8 oz of fruit juice every hour. d) test urine for ketones. e) call the provider if blood glucose is greater than 240 mg/dL.

c an early manifestation of hypoglycemia is irritability. drinking a glass of milk, which is approximately 15 g of carbohydrates, indicates understanding of the teaching.

a nurse is teaching a child who has type 1 diabetes mellitus about self-care. which of the following statements by the child indicates understanding of the teaching? a) "i should skip breakfast when i am not hungry." b) "i should increase my insulin with exercise." c) "i should drink a glass of milk when i am feeling irritable." d) "i should draw up the NPH insulin into the syringe before the regular insulin."

4 an insulin pump provides a small continuous dose of short-duration insulin subcutaneously throughout the day and night. the client can self-administer an additional bolus dose from the pump before each meal as needed. short-duration insulin is used in an insulin pump. an external pump is not attached surgically to the pancreas.

an external insulin pump is prescribed for a client with diabetes mellitus. when the client asks the nurse about the functioning of the pump, the nurse bases the response on which information about the pump? 1) it is timed to release programmed doses of either short-duration or NPH insulin into the bloodstream at specific intervals. 2) it continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels. 3) it is surgically attached to the pancreas and infuses regular insulin into the pancreas. this releases insulin into the bloodstream. 4) it administers a small continuous dose of short-duration insulin subcutaneously. the client can self-administer an additional bolus dose from the pump before each meal.

1 when a client with diabetes mellitus is unable to eat normally because of illness, the client still should take the prescribed insulin or oral medication. the client should consume additional fluids and should notify the PHCP. the client should monitor the blood glucose level every 3 to 4 hours. the client should also monitor the urine ketones during illness.

the home health nurse visits a client with a diagnosis of type 1 diabetes mellitus. the client reports a history of vomiting and diarrhea and tells the nurse that no food has been consumed for the last 24 hours. which additional statement by the client indicates a need for further teaching? 1) "i need to stop my insulin." 2) "i need to increase my fluid intake." 3) "i need to monitor my blood glucose every 3 to 4 hours." 4) "i need to call my primary health care provider because of these symptoms."

4 lack of insulin is the primary cause of DKA. treatment consists of insulin administration, intravenous fluid administration, and potassium replacement, followed by correcting acidosis. cardiac monitoring is important due to alterations in potassium levels associated with DKA and its treatment, but applying an electrocardiogram monitor is not the priority action.

the nurse is caring for a client admitted to the emergency department with diabetic ketoacidosis. in the acute phase, the nurse plans for which priority intervention? 1) correct the acidosis. 2) administer 5% dextrose intravenously. 3) apply a monitor for an electrocardiogram. 4) administer short-duration insulin intravenously.

1 chronic hyperglycemia, resulting from poor glycemic control, contributed to the microvascular and macrovascular complications of diabetes mellitus. classic symptoms of hyperglycemia include polydipsia, polyuria, and polyphagia. diaphoresis may occur in hypoglycemia. hypoglycemia is an acute complication of diabetes mellitus; however, it does not predispose a client to the chronic complications of diabetes mellitus.

the nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. which sign or symptom, if frequently exhibited in the client, indicates that the client is at risk for chronic complications of diabetes if the blood glucose is not adequately managed? 1) polyuria 2) diaphoresis 3) pedal edema 4) decreased respiratory rate

1, 3, 4 decreased blood glucose levels produce autonomic nervous system symptoms, which are manifested classically as nervousness, irritability, and tremors.

the nurse is monitoring a client who was diagnosed with type 1 diabetes mellitus and is being treated with NPH and regular insulin. which manifestations 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

2 an increased blood glucose level will cause the kidneys to excrete the glucose in the urine. the glucose is accompanied by fluids and electrolytes, causing an osmotic diuresis leading to dehydration. this fluid loss must be replaced when it becomes severe.

the nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. the nurse places priority on which client problem? 1) lack of knowledge 2) inadequate fluid volume 3) compromised family coping 4) inadequate consumption of nutrients

3 in the client with type 2 diabetes mellitus, an elevated temperature may indicate infection. infection is a leading cause of hyperosmolar hyperglycemic syndrome in the client with type 2 diabetes mellitus. the other findings are within normal limits.

the nurse performs a physical assessment on a client with type 2 diabetes mellitus findings include a fasting blood glucose level of 70 mg/dL, temperature of 101 degrees F, pulse of 82 beats per minute, respirations of 20 breaths per minute, and blood pressure of 118/68 mm Hg. which finding would be the priority concern to the nurse? 1) pulse 2) respiration 3) temperature 4) blood pressure

1 exenatide is an incretin mimetic used for type 2 diabetes mellitus only. it is not recommended for clients taking insulin. hence the nurse should withhold the medication and question the PHCP regarding this prescription.

the primary health care provider prescribes exenatide for a client with type 1 diabetes mellitus who takes insulin. the nurse should plan to take which most appropriate intervention? 1) withhold the medication and call the PHCP, questioning the prescription for the client. 2) teach the client about the signs and symptoms of hypoglycemia and hyperglycemia. 3) monitor the client for gastrointestinal side effects after administering the medication. 4) withdraw the insulin from the prefilled pen into an insulin syringe to prepare for administration.