Diabetic Drugs
A patient diagnosed with type 2 diabetic states, "I do not eat breakfast, but I will make sure to take my repaglinide." What is a correct response by the nurse? "The best meal to skip is breakfast." "This medicine does not regulate your blood glucose." "Skipping meals can cause your blood glucose to drop." "Taking this medication without food maintains your blood glucose."
"Skipping meals can cause your blood glucose to drop." Repaglinide is short acting and needs to be taken 30 minutes before meals so blood glucose does not drop.
Which patient with diabetes should the nurse assess first? A patient who reports palpitations and tachycardia A patient whose urine output is 400 ml within one shift A patient with blood glucose of 61 mg/dL who is complaining of a dry mouth A patient reporting abdominal pain who rates the pain as 4 on a scale of 1 to 10
A patient who reports palpitations and tachycardia Palpitations and tachycardia are signs and symptoms of hypoglycemia. This patient should be seen first and a blood glucose should be obtained.
A patient presents to the emergency department reporting heart palpitations. The patient is flushed, smells of alcohol, and is taking glipizide. What might the nurse suspect based on this clinical presentation? The alcohol is reacting with the glipizide. The patient is having a hypotensive crisis. The patient is having a hypertensive crisis. The alcohol has caused high blood glucose levels.
The alcohol is reacting with the glipizide. When alcohol is combined with a sulfonylurea medication such as glipizide, a disulfiram-like reaction may occur or potentiate the hypoglycemic effects of the sulfonylurea. Symptoms of the disulfiram-like reaction include flushing, palpitations, and nausea.
The nurse is preparing a combination of insulins for a subcutaneous injection. Which insulin should the nurse draw up first? Insulin glargine The fast-acting insulin The long-acting insulin The short-acting insulin
The short-acting insulin The short-acting insulin should be drawn into the syringe first to avoid contamination of the short-acting insulin by the NPH insulin. Only NPH insulin is appropriate for mixing with short-acting insulins.
A patient taking insulin has developed hypertension and has been prescribed a thiazide diuretic. Which statement made by the patient indicates a need for additional teaching about the interactions between the two medications? "My blood pressure should go down." "My insulin dose will need to be increased." "My insulin dose will need to be decreased." "My diet will not need to change if I take thiazide with insulin."
"My insulin dose will need to be decreased." Thiazide diuretics increase blood sugar, so the insulin dose would need to be increased, not decreased.
A patient with type 2 diabetes who has been admitted to the hospital for infection has been taking regular insulin for 10 years. Which statement made by the patient indicates a need for additional teaching? "My insulin needs will be increased." "My insulin needs will be decreased." "I will need to make sure I stay hydrated." "I will need to make sure I do not skip any meals."
"My insulin needs will be decreased." Blood glucose levels can be elevated during stressful times, such as during an infection. Insulin doses may need to be increased for a period of time.
I need to rotate my injection sites?" Which nursing response is correct? "There is no need to rotate injection sites." "You should apply an ice pack if you do not rotate sites." "Rotating injection sites in the abdomen promotes insulin absorption" "Rotating injection sites between the abdomen and thigh promotes insulin absorption."
"Rotating injection sites in the abdomen promotes insulin absorption" Absorption is fastest and most consistent following abdominal injections. Alternating sites reduces risk of lipodystrophy.
A nurse is providing patient education on repaglinide. Which statement is correct? "Take this medication 1 hour after eating." "Take this mediation with or without food." "Take this medication on an empty stomach." "Take this medication 30 minutes or less before eating."
"Take this medication 30 minutes or less before eating." Repaglinide is short acting and must be taken with a meal, 30 minutes or less before eating.
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A nurse is administering insulin glargine to a patient. What is the onset of action of this medication? 10 minutes 15-45 minutes 1-5 hours 6 hours
1-5 hours Insulin glargine is a long-acting insulin with an onset of action of 1-5 hours.
A nurse administering NPH insulin would expect peak effect to occur in what time frame? 1-2 hours 2-4 hours 6-12 hours 10-12 hours
6-12 hours NPH Insulin is an intermediate-acting insulin and has its peak effect at 6-12 hours.
At what time of day would a nurse expect to administer a dose of exenatide subcutaneously? Before the patient goes to bed Immediately after the patient wakes up 60 minutes or less after the patient's meal 60 minutes or less before the patient's meal
60 minutes or less before the patient's meal Exenatide is given to increase glucose control with type 2 diabetes. It should be administered twice a day, 60 minutes or less before the morning and evening meals.
What instructions should the nurse provide to a patient about an insulin pump prior to discharge? Select all that apply. Change the infusion set every 7 days. Start the pump prior to eating a meal. Change the infusion set every 1-3 days. Use the same site for the catheter each time. Move the catheter at least 1 inch away from the previous site.
Change the infusion set every 1-3 days. Infusion sets should be changed every 1-3 days. Move the catheter at least 1 inch away from the previous site. When replacing the catheter it is important to move the site at least 1 inch away from the previous site to avoid lipohypertrophy.
A nurse is treating an unconscious adult who is covered in sweat. The person has a history of diabetes. A blood glucose of 20 mg/dL is obtained. What should the nurse administer first? Glargine Glucagon Orange juice Regular insulin
Glucagon Glucagon should be administered to patients who are unconscious or unable to swallow.
A patient with type 2 diabetes has a blood glucose of 50 mg/dL and the patient's scheduled dose of insulin is due. What is the appropriate nursing intervention? Recheck blood glucose No intervention is needed Hold scheduled dose and give orange juice Administer scheduled dose and give orange juice
Hold scheduled dose and give orange juice Blood glucose should be above 60 mg/dL. If a patient with a blood glucose of less than 60 mg/dL receives insulin, the blood glucose will decrease more. Holding the scheduled dose and giving orange juice would be the appropriate intervention.
The nurse asks a patient to state the symptoms of hypoglycemia to assess understanding. Which symptom stated by the patient indicates a need for additional teaching? Sweating Excessive hunger Increased energy Racing heartbeat
Increased energy Increased energy is not a symptom of hypoglycemia. The patient should be taught that fatigue is a symptom of hypoglycemia.
What physiological response would the nurse expect in a patient after administration of insulin? Increased glucose uptake Decreased glucose uptake Decreased glucose storage Increased amino acid release
Increased glucose uptake Insulin stimulates cellular uptake of glucose, amino acids, nucleotides, and potassium. Insulin also promotes synthesis of complex organic molecules.
Which type of insulin has an onset time of 15 minutes? Insulin zinc Insulin lispro Insulin detemir Insulin isophane
Insulin lispro Insulin lispro is rapid-acting insulin with an onset time of 15 minutes.
Four patients have been prescribed a non-insulin drug. Following administration of the drug, each patient has developed new symptoms. Which assessment data would indicate that the patient has a priority need for nursing intervention? Itching and rash No appetite and fatigue Diarrhea and abdominal pain Nonproductive cough and chills
Itching and rash Itching and rash may indicate a hypersensitivity reaction to the medication and a potential anaphylaxis reaction. The patient with these symptoms would be given the highest priority.
Which oral non-insulin drug is contraindicated in patients with renal impairment? Acarbose Metformin Pioglitazone Rosiglitazone maleate
Metformin Metformin is contraindicated in patients with renal impairment due to an increased risk of development of lactic acidosis.
What oral anti-diabetic drug should be withheld for 48 hours before and after tests that require intravenous contrast dye? Metformin Repaglinide Rosiglitazone Pramlintide acetate
Metformin Intravenous contrast dye that contains iodine has the potential to cause acute chronic kidney disease. Because metformin is contraindicated in patients with renal dysfunction, it should be discontinued a day or two prior to the procedure and resumed 48 hours after the procedure, once lab results show normal renal function.
Upon assessment, the nurse finds that a patient who has type 2 diabetes is alert, awake, pale, and complaining of weakness and nervousness. Which action should the nurse take first? Administer dextrose 50% Obtain a blood glucose level Call the health care provider Administer table sugar under the tongue
Obtain a blood glucose level Obtaining a blood glucose level will help the nurse determine the type of treatment required.
The nurse is providing patient education on how acarbose helps treat diabetes. Which statement is most appropriate? Decreases the release of insulin from the pancreas Stimulates the release of insulin from the pancreas Reduces insulin resistance and decreases glucose production Prevents starches from immediately breaking down to simple sugars
Prevents starches from immediately breaking down to simple sugars Acarbose is an alpha-glucosidase inhibitor that slows the digestion of carbohydrates.
A home health nurse is visiting a patient with type 2 diabetes to prefill insulin syringes. Where should the nurse store the prefilled insulin syringes? Freezer Window sill Refrigerator Kitchen Counter
Refrigerator Prefilled syringes can be stored in a refrigerator for up to 2 weeks.
Which insulin can be administered intravenously? Regular insulin Insulin glargine Isophane insulin suspension NPH Insulin detemir
Regular insulin Regular insulin can be administered intravenously.
The nurse observes Cates as she administers her insulin injection. The nurse will determine that teaching has been effective when Cates completes these steps in what order? Insert the needle and inject the insulin. Select the site for the injection and cleanse it with an alcohol swab or soap and water. Roll the vial between the palms of the hands Eliminate any bubbles in the syringe. Invert the vial and remove the correct amount of insulin.
Roll the vial between the palms of the hands Invert the vial and remove the correct amount of insulin. Eliminate any bubbles in the syringe. Select the site for the injection and cleanse it with an alcohol swab or soap and water. Insert the needle and inject the insulin.
Which non-insulin drug(s) should not be administered to a patient who is breastfeeding? Sitagliptin Repaglinide Pioglitazone Sulfonylureas
Sulfonylureas Sulfonylureas are contraindicated in pregnant and breastfeeding women.
What class of medications is contraindicated for a patient with type 1 diabetes? Sulfonylureas SGLT-2 inhibitors Amylin analogues Long-acting insulins
Sulfonylureas In type 1 diabetes, the pancreas is incapable of insulin synthesis. Sulfonylureas act primarily on the release of insulin from the pancreas and will therefore be ineffective.
A type 2 diabetic patient who has been taking pioglitazone for 5 years has recently been diagnosed with heart failure. Which intervention can the nurse expect the health care provider to implement? The current medication will be changed. The current medication will be increased. The current medication will be decreased. Rosiglitazone will be prescribed in place of pioglitazone.
The current medication will be changed. Pioglitazone increases plasma volume, causing fluid retention, and is contraindicated for patients with heart failure.
The nurse should instruct Cates to immediately report which symptoms? Select all that apply. Thirst Vomiting Constipation Increased urine output Sweet, fruity breath odor
Thirst Thirst is a sign of hyperglycemia and should be reported immediately. Increased urine output Increased urine output is a sign of hyperglycemia and should be reported immediately. Sweet, fruity breath odor Sweet, fruity breath odor is a sign of hyperglycemia and should be reported immediately.
What nursing intervention is best practice prior to the administration of insulin? Obtaining of vital signs Weighing of the patient Verification of the patient's age Verification of the dosage by two nurses
Verification of the dosage by two nurses Insulin is a high-risk drug; so two nurses are required to verify the dosage for patient safety.
What onset of action would a nurse expect when administering glyburide? Within 1 hour After 3 hours Between 4-6 hours Between 8-10 hours
Within 1 hour Glyburide has a rapid onset of action within 1 hour of administration.