NUR 3420 - PrepU Ch 41 - Exam 4
Oral Explanation: Sitagliptin is administered orally.
A client is prescribed sitagliptin. The nurse would expect to administer this drug by which route?
U-10 (10 units/mL) insulin Explanation: Administration of insulin for infants and toddlers who weigh less than 10 kg or require less than 5 units of insulin per day can be difficult because small doses are hard to measure in a U-100 syringe. Use of diluted insulin allows more accurate administration. The most common dilution strength is U-10 (10 units/mL), and a diluent is available from insulin manufacturers for this purpose. Vials of diluted insulin should be clearly labeled and should be discarded after 1 month.
A 2-month-old male child is diagnosed with diabetes. His parents are having difficulty measuring 2 units of insulin in the U-100 syringe. What would the nurse expect the health care provider to order?
The client jogs two miles in the morning before he goes to work. Explanation: Physical exercise, such as jogging, changes insulin requirements and may result in a delayed hypoglycemic reaction. The fact that he likes to nap before dinner and has an early lunch is unrelated to his hypoglycemia. The client eating oatmeal early in the morning would help stabilize his blood sugars until later in the morning, but the jogging would have a dramatic effect.
An insulin-dependent diabetic male client is having trouble with hypoglycemia late in the morning. During the health history, the nurse becomes aware of the most likely cause. What would cause the late morning hypoglycemia?
increasing insulin secretion from the pancreas. Explanation: The hypoglycemic action of glyburide results from the stimulation of pancreatic beta cells, leading to increased insulin secretion.
The health care provider prescribes glyburide for a client who is a newly diagnosed type 2 diabetic. The nurse knows that this medication produces hypoglycemia by:
126 mg/dL Explanation: A FPG result (126 mg/dL) on two separate occasions is diagnostic of diabetes, values of 100 to 125 mg/dL are termed impaired fasting glucose, and values less than 100 mg/dL are considered normal.
The nurse is discussing diabetes mellitus with a group of people who are involved in a weight loss program. The nurse relates to the group that the parameters for a diagnosis of diabetes are a fasting plasma glucose test (FPG) greater than or equal to what level on two separate occasions?
06:45 Explanation: With short-acting insulins like lispro, aspart, or glulisine, it is important to inject the medication about 15 minutes before eating.
The client is scheduled to get a breakfast tray at 07:00. At what time should the client receive a prescribed dose of insulin lispro?
HbA1c Explanation: The nurse anticipates that the glycosylated hemoglobin (HbA1c) will be ordered for this client because it provides an average of the client's blood glucose level for the last three- to four-month period. It will also tell how well controlled the client's blood glucose is. A stat urine for glucose and an FBG in the AM will only indicate the client's current blood glucose level, not how well it is being controlled. An insulin level will not give the information needed to understand the client's control of blood glucose.
The nurse is interviewing a client who was diagnosed with type 2 diabetes four months ago. The client does not records glucometer readings but reports no concerns. What laboratory test does the nurse anticipate the health care provider will order for this client?
Insert the needle at a 45-degree angle for injection. Explanation: The vial should be gently rotated and vigorous shaking is to be avoided to ensure uniform suspension of the insulin. Typically the area is pinched to allow access to the loose connective tissue layer. The needle is inserted at a 45-degree angle for subcutaneous administration. Gentle pressure should be applied at the injection site.
When administering insulin, what would be most appropriate?
"Please continue taking the medication and monitoring your weight. This is an expected outcome of this drug therapy." Explanation: The nurse should advise the client to continue therapy as prescribed because weight loss is a beneficial adverse effect for type 2 diabetics. The client need not seek a decrease in dosage or change in medication, nor would discontinuation of the drug be warranted.
A 59-year-old man with type 2 diabetes is prescribed metformin. When the client returns to the clinic, he reports that he has lost 8 pounds in a month. How should the nurse respond?
Client's average blood glucose is above normal. Explanation: The American Diabetes Association (ADA) suggests a target A1C of less than 7%. A1C should be measured every 3 to 6 months. An A1C of 9 indicates that the client's average blood glucose is consistently above normal.
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?
use of alcohol. Explanation: The nurse should assess the client's alcohol consumption before therapy is initiated. Concomitant alcohol use increases the rate of glyburide metabolism and may cause a disulfiram-like reaction. Even though the client's blood pressure should be assessed, it is not as important as making sure that the client is aware of the serious reaction that alcohol can cause while on glyburide. The amount of salt used in the patient's diet is important as well as the client's potassium level, but not specifically in relation to the use of glyburide
A male client is to begin glyburide (Diabeta) for type 2 diabetes. Before the drug therapy begins, a priority action by the nurse will be to assess the client's:
Obesity Explanation: The nurse informs the patient that obesity is a risk factor associated with type 2 diabetes. Young age and regular exercise are not risk factors for type 2 diabetes. Polyuria is a symptom of diabetes and not a risk factor leading to type 2 diabetes
A nurse is caring for a patient diagnosed with type 2 diabetes. What should the nurse inform the patient are risk factors associated with type 2 diabetes?
insulin glargine Explanation: Insulin glargine is an example of a long-acting insulin. Insulin lispro and insulin aspart are rapid-acting insulin. Isophane insulin suspension is an intermediate-acting insulin.
After reviewing information about different insulin preparations, a nursing student demonstrates understanding of the information when the student identifies which medication as an example of a long-acting insulin?
Metformin Explanation: Metformin is classified as a biguanide. Miglitol is an alpha-glucosidase inhibitor. Tolbutamide is a first generation sulfonylurea. Glipizide is a second generation sulfonylurea.
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?
Subcutaneous injection Explanation: Subcutaneous injection currently is the most common method for administering insulin.
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?
Malaise Tachypnea Abdominal pain Muscular pain Explanation: Symptoms of lactic acidosis include malaise, abdominal pain, tachypnea, shortness of breath, and muscular pain
Lactic acidosis can occur in clients receiving metformin (Glucophage), especially those with renal impairment. What are symptoms of lactic acidosis for which a nurse should monitor a client taking metformin (Glucophage)? Select all that apply:
Some of the drug is absorbed into the plastic tubing set. Explanation: While it is important for the nurse to monitor the client closely in order to minimize the risk of adverse effects or control high fluctuations in glucose levels, when regular insulin is given by IV infusion, close monitoring of the therapeutic effect is necessary. This is because some of the drug is absorbed into the plastic tubing set, and it is not possible to determine the exact amount that will be lost and never received by the patient. Regular insulin via the IV route does not result in a slower onset of action. The client will not be eating large amounts of food, and oral administration of insulin is never possible.
Mr. Hoss is admitted to the hospital in DKA. The health care provider prescribes an insulin drip. The nurse is monitoring his blood glucose every hour. What is most likely to be the reason for this?
Regular insulin Explanation: Only regular insulin can be administered IV. No other insulins or oral antidiabetic medications can be given IV.
The nurse is caring for a postoperative client whose diabetes has been well controlled on acarbose (Precose). The client is not allowed to take anything orally following complications of abdominal surgery and is receiving high-glucose total parenteral nutrition via a central IV line. What medication can the nurse administer intravenously to control the client's blood glucose level?
An alcoholic patient Explanation: Hypoglycemia is more common when metformin is administered concomitantly with other oral hypoglycemic agents, if caloric intake is deficient, or if the patient exercises strenuously. The nurse must caution patients against excessive alcohol intake while taking metformin, because alcohol use increases the risk for lactic acidosis. Also, concurrent use with chromium, garlic, gymnema, or alcohol may increase the risk for hypoglycemia. Hypoglycemia is not likely to occur more in pregnant women, patients with a predilection for sweets or candies, or patients who are allergic to seafood.
The following patients are prescribed metformin. Which patient is likely at the greatest risk of having an adverse reaction to metformin?
Prepare a week's supply of syringes and refrigerate. Explanation: Older adults can have many underlying problems that complicate diabetic therapy. Poor vision and/or coordination may make it difficult to prepare a syringe. A week's supply of syringes can be prepared and refrigerated for the usual dose of insulin. If the client is using insulin it is most likely because oral antidiabetic medications don't work. A magnifying glass is impractical because drawing up medication requires two hands and a magnifying glass will not help the client to see well enough to be safe. It is a big imposition to expect a neighbor to be constantly available and this would not be the best choice.
The home care nurse is caring for an older adult client who has type 1 diabetes. The client has visual impairment and cannot read the numbers on the syringe when preparing insulin for administration nor afford the cost of prefilled auto syringes. What strategy might the nurse use to help this client comply with insulin needs between visits?
"Insulin assists glucose molecules to enter the cells of muscle and fat tissues." Explanation: Insulin appears to activate a process that helps glucose molecules enter the cells of striated muscle and adipose tissue. It also stimulates the synthesis of glycogen by the liver, promotes protein synthesis, and helps the body store fat by preventing its breakdown for energy.
The nurse is discussing diabetes with a group of individuals who are at risk for the disease. Which statement by a participant indicates an understanding of the role of insulin in the disease?
Exercise Decreased food intake Explanation: Exercise and decreased food intake decrease insulin needs; fever, anxiety, and stress all will increase insulin needs for the client with type 1 diabetes
The nurse is providing teaching to a client with type 1 diabetes. The client requires additional teaching when he learns that his insulin needs may increase because of what condition? (Select all that apply.)
Orange or other fruit juice Glucose tablets Hard candy Explanation: Methods of terminating a hypoglycemic reaction include the administration of one or more of the following: orange or other fruit juice, hard candy or honey, glucose tablets, glucagon, or glucose 10 percent or 50 percent IV.
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.)
100 to 250 mg per day Explanation: The appropriate dosage range for oral chlorpropamide is 100 to 250 mg/d. Tolbutamide is 0.25 to 3 g/d. Glimepiride is 1 to 4 mg/d. Glipizide is taken 5 mg PO daily
The nurse transcribes an order for chlorpropamide (Diabinese). What is an appropriate dosage range for this medication?
Metformin Explanation: Metformin is the only oral antidiabetic drug approved for children. It has established dosage for children 10 years of age and older. With the increasing number of children being diagnosed with type 2 diabetes, the use of other agents in children is being tested. Because metformin is the only drug approved for use with children, pioglitazone, repaglinide, and luraglutide would not be appropriate.
What antidiabetic agent is approved for the nurse to administer to children 10 years old and older with type 2 diabetes?
Exogenous insulin is required for life. Explanation: Type 1 diabetes results from an autoimmune disorder that destroys pancreatic beta cells. Insulin is the only effective treatment for type 1 diabetes because pancreatic beta cells are unable to secrete endogenous insulin and metabolism is severely impaired. In type I diabetes, blood glucose levels cannot be controlled with diet, oral agents cannot control the disease process, and it does not always start in childhood.
When learning about type 1 diabetes, what would the student nurses learn is a distinguishing characteristic of this disease?
7% Explanation: Results vary with the laboratory method used for analysis, but in general, levels between 6.5% and 7% indicate good control of diabetes. Results of 10% or greater indicate poor blood glucose control for the last several months.
Which HbA1c result would indicate that a client's diabetes is under good control?
impaired glucose tolerance obesity history of gestational diabetes Explanation: A nurse should be able to identify all the risk factors for type-2 diabetes in a client. These include: obesity, older age, family history of diabetes, history of gestational diabetes, impaired glucose tolerance, minimal or no physical activity, and race/ethnicity (Black Americans, Hispanic/Latino Americans, Native Americans, and some Asian Americans).
Which are risk factors for type-2 diabetes that a nurse should recognize in a client? Select all that apply:
Glucagon Explanation: The client is significantly hypoglycemic and needs emergency treatment. Glucagon would be the agent of choice to raise the client's glucose level because it can be given intravenously and has an onset of approximately 1 minute. Diazoxide can be used to elevate blood glucose levels, but it must be given orally. Lispro and regular insulin would be used to treat hyperglycemia
A man is brought to the emergency department. He is nonresponsive, and his blood glucose level is 32 mg/dL. Which would the nurse expect to be ordered?
Inspect the previous injection site for inflammation. Explanation: The nurse should check the previous injection site before administering each insulin dose. The injection sites should be rotated to prevent lipodystrophy. Prefilled syringes should not be kept horizontally; they should be kept in a vertical or oblique position to avoid plugging the needle. The nurse checks for symptoms of myalgia or malaise when administration of metformin leads to lactic acidosis. Insulin should be kept at room temperature for administration. Insulin is refrigerated if it needs to be stored for up to three months for later use.
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?
Give oral fluids or candy. Explanation: The nurse should administer oral fluids or candy to the hypoglycemic patient with swallowing and gag reflexes. If the patient is unconscious the nurse should administer glucose or glucagon parenterally. The nurse should administer insulin through an insulin pump to special categories of diabetic patients, such as pregnant women with diabetes and renal transplantation. Oral antidiabetic drugs are administered to patients with type 2 diabetes
A nurse is caring for a patient who has developed a hypoglycemic reaction. Which intervention should the nurse perform if swallowing and gag reflexes are present in the patient?
insulin lispro Explanation: Insulin lispro is an example of a rapid-acting insulin. Insulin glargine and insulin detemir are long-acting insulin. Isophane insulin suspension is an intermediate-acting insulin.
A nurse is preparing to administer a rapid-acting insulin. Which medication would the nurse most likely administer?
weakness, sweating, and decreased mentation. Explanation: Symptoms of hypoglycemia include shakiness, dizziness, or light-headedness, sweating, nervousness or irritability, sudden changes in behavior or mood, weakness, pale skin, and hunger.
The nurse is caring for a client taking insulin. The nurse realizes the client is experiencing symptoms of hypoglycemia when the client displays:
Do not give pramlintide in the same site where insulin is administered. Explanation: Clients who take pramlintide should not be injected into the same site where insulin is administered.
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?
regular Explanation: Regular insulin (insulin injection) has a rapid onset of action and can be given intravenously. Therefore, it is the insulin of choice during acute situations, such as DKA, severe infection or other illness, and surgical procedures. All the other options are administered subcutaneously
When considering the management of diabetic ketoacidosis (DKA), what type of insulin can be administered intravenously?
Occurs before age 20 Insulin supplementation is required for survival Explanation: Type 1 diabetes is formerly known as insulin-dependent diabetes mellitus. It usually has a rapid onset and occurs before age 20. Those with type 1 diabetes produce insulin in insufficient amounts, and therefore must have insulin supplementation to survive. Type 1 diabetes is an autoimmune disorder therefore obesity is not a risk factor.
What best describes type 1 diabetes? (Select all that apply.)
Increases insulin release Explanation: Incretins increase insulin release, decrease glucagon release, slow GI emptying, and stimulate the satiety center. Growth hormone increases protein building.
When describing the effects of incretins on blood glucose control to a group of students, which would an instructor include?
Massaging the site after removing the needle Explanation: Gentle pressure should be applied to the injection after the needle is withdrawn. Massaging could contribute to erratic or unpredictable absorption
Which would be least appropriate when administering insulin by subcutaneous injection?
Metformin does not cause hypoglycemia. Explanation: Experts prefer to call metformin an antihyperglycemic rather than a hypoglycemic because it does not cause hypoglycemia, even in large doses, when used alone. This fact about metformin makes the other statements inaccurate.
A client has refused a scheduled dose of metformin, stating that he/she is worried about inducing hypoglycemia because his/her blood glucose level is currently 66 mg/dL (3.66 mmol/L). The nurse should convey what teaching points to the client?
Glycosylated hemoglobin (HbAlc) levels Explanation: HbAlc levels provide a 3-month average of glucose levels, which provides the best evaluation tool to measure of the overall patient response to the treatment plan. Blood pressure readings would be used to evaluate a client's response to a antihypertensive drug. Bilirubin could indicate liver function. Fasting blood glucose levels provide only a baseline blood sugar and no historical overview.
A diabetic client is taking regular and NPH insulin to manage diabetes. What is the best evaluation tool to measure the overall client response to the insulin therapy?
humulin R Explanation: Regular insulin (Humulin R) is clear, whereas intermediate-acting (Humulin N and Humulin L) and long-acting (Humulin U) insulins are cloudy.
A nurse is preparing to administer an insulin that is clear. Which insulin would the nurse most likely administer?
Regular (Humulin R) Explanation: Regular insulin has the quickest onset of 30-60 minutes. PZI and ultralente have an onset of 4-8 hours. NPH has an onset of 60-90 minutes.
A student asks the nursing instructor what insulin has the quickest therapeutic effect once administered. What would be the best response?
"I'll plan to take my glyburide each night before I go to bed." Explanation: Glyburide is normally taken in the morning, before breakfast. No drug cures diabetes; the goal of therapy is the maintenance of safe blood glucose levels. The client should check before taking other drugs and should indeed be aware of the risk of hypoglycemia.
A young man has been diagnosed with type 2 diabetes and has been prescribed glyburide. Which statement suggests that the nurse should perform further health education?
hyperglycemia and glycosuria. Explanation: The most frequently recognized clinical signs of diabetes are hyperglycemia (fasting blood sugar level greater than 106 mg/dL) and glycosuria (the presence of sugar in the urine).
The nurse educator works at the diabetes clinic. When talking to a class of adolescent diabetics, the educator tells the students that the most recognized signs of diabetes are:
Regular insulin Explanation: Regular insulin is a short-acting insulin that manages the hyperglycemia and hyperkalemia of DKA (diabetic ketoacidosis), which is a life-threatening complication that occurs with severe insulin deficiency. Humulin N, Humulin L, and NPH are intermediate-acting insulins.
A client is admitted to the Emergency Department in diabetic ketoacidosis (DKA) with a blood glucose level of 33 mmol/L. The provider orders an initial dose of 25 U insulin IV. Which type of insulin will be administered?
Regular. Explanation: In general, regular insulin, a short-acting insulin, is used with major surgery or surgery requiring general anesthesia. IV administration of insulin is preferred because it provides more predictable absorption than subcutaneous injections. Only regular insulin is administered IV.
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:
liver enzymes Explanation: Rosiglitazone has been associated with hepatotoxicity and requires monitoring of liver enzymes. Liver function tests (e.g., serum aminotransferase enzymes) should be checked before starting therapy and every 2 months for 1 year, then periodically. Platelets, D-dimer, and tests of renal function are less significant to the safety and efficacy of treatment
Rosiglitazone is being considered for the treatment of diabetes in an adult male client. Before the initiation of rosiglitazone therapy, the nurse should review what laboratory work recently drawn?
Check the dosage with another nurse. Explanation: After preparing the syringe with insulin, the nurse should then have the medication and dosage checked by a second nurse to make sure that it is correct. It is not necessary to recheck the client's blood sugar again. It is important to know when the client will be eating again; make sure that it is within the next 30 minutes. However, this is not the nurse's next step. Then the nurse will administer the insulin to the client
The nurse is preparing to administer a mixture of 12 units regular insulin and 45 units NPH insulin to a client with a blood sugar of 378 mg/dL. After the nurse draws the medication into the syringe, what is the nurse's next action?
"Repaglinide rapidly stimulates insulin production, so you need to eat soon after taking the medication." Explanation: Glyburide is a second-generation sulfonylurea that stimulates insulin release from the beta cells in the pancreas with a 2- to 4-hour onset of action. Repaglinide has an onset of action within 30 minutes with peak effect in 1 hour, and duration of action is approximately 3 to 4 hours. Because repaglinide has a much faster onset of action, it is important the client eats within 15 to 30 minutes after taking the drug to avoid hypoglycemia. Repaglinide is not less potent, it is not more potent, and the two medications are not virtually the same
What instructions should the nurse give to a client with type 2 diabetes who has been switched from glyburide (DiaBeta) to repaglinide?
Assess the most recent hemoglobin A1C levels. Explanation: Health care providers also look at the glycosylated hemoglobin (hemoglobin A1C) levels to assess the effectiveness of treatment. Because glucose stays attached to hemoglobin for the life of the red blood cell, which is about 120 days, the hemoglobin A1C level reflects the average blood glucose level over the past 3 months. Reviewing blood glucose readings, measuring the client's random blood glucose, and dialoguing with the client are all therapeutic strategies, but hemoglobin A1C is most accurate.
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?
the past 3 or 4 months Explanation: Glycosylated hemoglobin measures glucose control over the past 3 to 4 months. When blood glucose levels are high, glucose molecules attach to hemoglobin in the red blood cell. The longer the hyperglycemia lasts, the more glucose binds to the red blood cell and the higher the glycosylated hemoglobin. This binding lasts for the life of the red blood cell (about 4 months) so the other time frames would not be accurate.
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?
Insulin is needed because the beta cells of the pancreas are no longer functioning. Explanation: Insulin is needed in type 1 diabetes because the beta cells of the pancreas are no longer functioning. With type 2 diabetes, insulin is produced, but perhaps not enough to maintain glucose control or the insulin receptors are not sensitive enough to insulin.
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?
Between 8:30 AM and 9:30 AM Explanation: With insulin lispro, peak effects would occur in 30 to 90 minutes or between 8:30 AM and 9:30 AM. Regular insulin peaks in 2 to 4 hours, so the nurse would be alert for signs and symptoms of hypoglycemia at this time, which would be between 10 AM and 12 noon. With insulin detemir, peak effects would occur in 6 to 8 hours, or between 2 PM and 4 PM. With NPH insulin, peak effects would occur in 4 to 12 hours, or between 12 noon and 8 PM.
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?
"The different onsets and peaks of the two types provide better overall glucose control." Explanation: Regular insulin will begin working within 30 to 60 minutes and peak within 2 to 4 hours and a 6- to 12-hour duration of action whereas NPH insulin has an onset of 60 to 90 minutes and peaks in 4 to 12 hours, with a 24-hour duration of action. By giving both drugs at once, the client gets rapid blood glucose control within 30 minutes from the regular insulin and the control lasts 24 hours due to NPH's long duration of action. NPH has no effect on the breakdown of regular insulin and there is not necessarily a reduced risk of adverse effects. NPH does not stimulate the pancreas toward increased insulin production.
A client with type 1 diabetes has been prescribed 12 units of regular insulin and 34 units of NPH insulin in the morning. How should the nurse explain why two different types of insulin are required to control the client's blood glucose?
insulin lispro Explanation: Insulin lispro has a 15-minute onset of action. NPH, 70/30, and regular insulin have longer onsets of action, a later peak, and a longer duration of action
A client's current condition requires rapid reduction of blood sugar levels. Which type of insulin will have the most rapid onset of action?
It decreases intestinal absorption of glucose and improves insulin sensitivity. Explanation: Metformin decreases the intestinal absorption of glucose and improves insulin sensitivity, while glyburide works by stimulating insulin release from the beta cells of the pancreas and reducing glucose output from the liver. On the other hand, postprandial glucose levels substantially are reduced by acarbose and miglitol when administered either alone or in combination with insulin or sulfonylurea.
A female client is prescribed metformin to decrease her blood glucose levels associated with diabetes mellitus type 2. Which statement accurately describes the action of metformin?
Take an oral dose of some form of glucose as soon as possible. Explanation: The initial action of the client should be to take some form of oral glucose. It would also be appropriate to call the provider, but this will delay self-treatment and should be done after the administration of the glucose. Injecting insulin would cause further harm to the client and is not an option. It is good to stay calm, but the reaction will not subside without intervention.
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?
Check the expiration date on the vial. Check the health care provider's orders for the type and dosage of insulin. Remove all air bubbles from the syringe barrel. Explanation: Prior to administering insulin glargine (Lantus) to a client, the nurse must complete the following pre-administration steps: carefully check the provider's order for the type and dosage of insulin, check the expiration date on the vial, gently rotate the vial between the palms of the hands, and gently tilt end-to-end before withdrawing the insulin, remove all air bubbles from the syringe barrel, and never mix or dilute insulin glargine (Lantus) with any other insulin or solution because the insulin will not be effective.
A nurse should take what steps prior to administering insulin glargine (Lantus) to a client? Select all that apply.
"It stimulates insulin production, so you need to eat soon after taking the medication." Explanation: Glyburide's onset of action is 2 to 4 hours, and its duration is 24 hours. Repaglinide's onset of action is within 30 minutes, peak is 1 hour, and duration is approximately 3 to 4 hours. Repaglinide is taken 15 to 30 minutes before each meal because it stimulates the pancreas to secrete insulin to correspond to the food intake. If there is no food intake, the person is at risk of hypoglycemia. Glyburide, a sulfonylurea, also stimulates pancreatic cells, but not until 2 to 4 hours after it is taken. Repaglinide is not less potent, it is not more potent, and the two medications are not virtually the same.
What instructions would be important to give to a 50-year-old client with type 2 diabetes who has been switched from glyburide (DiaBeta), a sulfonylurea, to repaglinide, a meglitinide?
"Regular exercise makes your body better able to use the insulin it produces." Explanation: People who need less than 0.5 units/kg/d may produce some endogenous insulin, or their tissues may be more responsive to insulin because of exercise and good physical conditioning. Exercise is an extremely strong hypoglycemic agent. Diabetics need to check their blood sugar level regardless of whether they are or are not prescribed insulin. The need for insulin injections is determined by the function of the pancreas and its ability to produce sufficient quantities of insulin. It is not correct to assume diet is the only factor in this process. Alcohol should be avoided, and the dosage of oral antidiabetic medication should not be altered without guidance from a health care provider.
What statement would be appropriately included in the teaching concerning type 2 diabetes?
