NURS 401: Ch. 28 (Karch)

The nurse has just completed discharge instructions to a client who will be using a pen device to deliver his insulin dose. What statement by the client indicates a need for further instruction? "This will make it easier for me to give my own insulin because of my poor eyesight." "I need to turn the dial on the pen and listen for the locking ring before administering my insulin." "If I forget to take my insulin pen, I will be able to use the one that my wife uses." "I determine my dosage by the number of clicks that I hear."

"If I forget to take my insulin pen, I will be able to use the one that my wife uses." Explanation: Insulin pens are client-specific because the needle may be used multiple times and may be contaminated with blood. Also, the pen is prefilled with a specific type of insulin. The client selects the desired units by turning a dial and listening for a locking ring. The insulin dose is determined by the number of clicks heard. It is a useful method for clients who have poor eyesight.

The nurse is providing discharge instructions to a client who has just been diagnosed with type 1 diabetes. What instructions are most important for the client to follow related to diet? (Select all that apply.) If you skip a meal, increase your next insulin dosage. Avoid drinking beer, wine, or liquor. Lose 10-15 pounds. Use artificial sweeteners instead of sugar in tea and coffee. Read food labels carefully to look for hidden sources of sugar.

Avoid drinking beer, wine, or liquor. Use artificial sweeteners instead of sugar in tea and coffee. Read food labels carefully to look for hidden sources of sugar. Explanation: The client should be encouraged to follow a prescribed diet, know how many calories are allowed, and know how to do food exchanges. The client should follow an established meal schedule and avoid skipping meals. If a meal is skipped, the next insulin dose may need to be lowered, not raised. The client should be encouraged to use artificial sweeteners and to read food labels carefully. The client should avoid alcohol, dieting, and commercial weight-loss products.

A nurse is assigned to administer glargine to a patient at a health care facility. What precaution should the nurse take when administering glargine? Shake the vial vigorously before withdrawing insulin. Avoid mixing glargine with other insulin. Administer insulin that has been refrigerated. Administer glargine via IV route.

Avoid mixing glargine with other insulin. Explanation: When administering glargine to the patient, the nurse should avoid mixing it with other insulin or solutions. It will precipitate in the syringe when mixed. If glargine is mixed with another solution, it will lose glucose control, resulting in decreased effectiveness of the insulin. Glargine is administered via SC once daily at bedtime. The nurse should not shake the vial vigorously before withdrawing insulin. The vial should be gently rotated between the palms of the hands and tilted gently end-to-end immediately before withdrawing the insulin. The nurse administers insulin from vials at room temperature. Vials are stored in the refrigerator if it is to be stored for about three months for later use.

A client receives a dose of insulin lispro at 8 AM. The nurse would be alert for signs and symptoms of hypoglycemia at which time? Between 2 PM and 4 PM Between 12 noon and 8 PM Between 10 AM and 12 noon Between 8:30 AM and 9:30 AM

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 nurse is caring for a 48-year-old woman who has been hospitalized after injecting the wrong type of insulin. Which sign of hypoglycemia will the nurse be careful to observe for? Dry skin Flushing of the face Blurred vision Fruity breath

Blurred vision Explanation: Blurred or double vision (diplopia), fatigue, trembling, irritability, headache, nausea, numbness, muscle weakness, hunger, tachycardia, sweating, and nervousness are signs of a hypoglycemic reaction. Fruity breath can be an indication of ketoacidosis, and flushing of the face is a sign of hyperglycemia. Dry skin is unrelated to hypoglycemia

A female client is a newly diagnosed diabetic. She is a stay-at-home mother and responsible for meal planning and management of the home. What will the home care nurse teach this client? (Select all that apply.) Watch the client draw up and administer her insulin. Reinforce instructions on dealing with hypoglycemia. Assist the client in making menus that will meet the needs of both the client and the family. Instruct the client to go to the emergency department immediately if she develops a cold or upper respiratory infection. Encourage the client to check her blood glucose every hour.

Correct response: Assist the client in making menus that will meet the needs of both the client and the family. Watch the client draw up and administer her insulin. Reinforce instructions on dealing with hypoglycemia. Explanation: The home care nurse would assist the client and family to know how to plan meals that meet the needs of the client and the family. The nurse would also want to assure that the client knows how to administer insulin correctly and would need to make sure that the client understands how to deal with hypoglycemia.

The nurse is educating a client who will be adding an injection of pramlintide to his insulin regimen. What information is most important for the nurse to share with this client to ensure safe medication administration? Mix pramlintide in the same syringe with insulin. Inject pramlintide in the same site where insulin is administered. Do not give pramlintide in the same site where insulin is administered. Pramlintide should only be injected in the hip.

Do not give pramlintide in the same site where insulin is administered. Explanation: Clients who take pramlintide should not be injected into the same site where insulin is administered.

The nurse is administering an antidiabetic agent by subcutaneous injection within 60 minutes of the client's breakfast. Which agent would the nurse most likely be administering? Miglitol Exenatide Repaglinide Rosiglitazone

Exenatide Explanation: Exenatide is administered by subcutaneous injection within 60 minutes before morning and evening meals. Rosiglitazone would be administered as a single oral dose. Repaglinide is used orally before meals. Miglitol is given orally with the first bite of each meal.

Which would a nurse identify as an example of a sulfonylurea? Glyburide Metformin Miglitol Acarbose

Glyburide Explanation: Glyburide is an example of a sulfonylurea. Metformin is classified as a biguanide. Acarbose and miglitol are alpha-glucosidase inhibitors.

The health care provider has ordered a change of prescription from rapid-acting insulin to an intermediate-acting type. Which adverse effect must the nurse closely monitor for in the client? Hypotension Hypoglycemia Bradycardia Lipodystrophy

Hypoglycemia Explanation: Changing the type of insulin requires caution, and the client should be carefully monitored for hypoglycemia or hyperglycemia, either of which may occur as the body adjusts to the different pharmacokinetics of the preparation. However, hypoglycemia may cause an increased sympathetic activity and manifest as tachycardia. Lipodystrophy is caused by the breakdown of subcutaneous fat because of repeated insulin injections at the same site. A change of insulin prescription is not known to cause hypotension.

When administering insulin, what would be most appropriate? Insert the needle at a 45-degree angle for injection. Firmly spread the skin of the area of the intended site of injection. Shake the vial vigorously to ensure thorough mixing before drawing up the dose. Massage the injection site firmly after removing the needle and syringe.

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.

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? Check for symptoms of myalgia or malaise. Inspect the previous injection site for inflammation. Do not administer insulin kept at room temperature. Keep prefilled syringes horizontally.

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 client is prescribed sitagliptin. The nurse would expect to administer this drug by which route? Oral Intramuscular Intravenous Subcutaneous

Oral Explanation: Sitagliptin is a DDP-4 Inhibitor and is administered orally.

Which agent would a nurse expect to administer as a single oral dose in the morning? Miglitol Repaglinide Exenatide Rosiglitazone

Rosiglitazone Explanation: Rosiglitazone would be administered as a single oral dose. Repaglinide is used orally before meals. Exenatide is administered by subcutaneous injection within 60 minutes before morning and evening meals. Miglitol is given with the first bite of each meal.

A 42-year-old male client is prescribed glargine insulin for management of his type 2 diabetes mellitus. The nurse caring for the client develops a teaching plan regarding glargine insulin therapy. Which statement made by the client indicates that the client needs additional teaching? "I must give this insulin alone and not mix with other insulins." "The medication will peak in 3 hours." "I should not administer the insulin if it is cloudy." "The insulin is given only once per day, at night."

The medication will peak in 3 hours." Explanation: Insulin glargine (rDNA) is characterized by a chemical structure that regulates its release from the SC tissue into the circulation, providing a relatively constant glucose-lowering effect with no pronounced peak of action over a 24-hour period. Glargine, unlike NPH, is a clear insulin, similar to regular insulin in its appearance. Extreme caution must be used not to confuse glargine with regular insulin because serious adverse effects, including hypoglycemia, can occur. Glargine must not be diluted or mixed with any other insulin or solution because its onset of action may be delayed, and the solution will become cloudy. Insulin glargine is administered subcutaneously once daily at bedtime.

A patient with type 1 diabetes has come to the clinic for a routine follow-up appointment. While assessing the patient's skin, the nurse observes brown spots on his lower legs. What might these spots indicate? Poor insulin injection technique Infection Impaired glucose tolerance Widespread changes in the blood vessels

Widespread changes in the blood vessels Explanation: Diabetes can cause significant vascular problems. Brown spots on the lower legs of a diabetic patient are caused by small hemorrhages into the skin and may indicate widespread changes in the blood vessels.

Which factor would prohibit the administration of glipizide? allergy to sulfonamides the ingestion of carbohydrates increase in alkaline phosphatase a diagnosis of hypertension

allergy to sulfonamides Explanation: Sulfonylureas are contraindicated in clients with hypersensitivity to them, with severe renal or hepatic impairment, and who are pregnant. A diagnosis of hypertension does not cause contraindication of sulfonylureas. The client should consume carbohydrates in association with the oral hypoglycemic agent. An increase in alkaline phosphatase does not result in the contraindication of glipizide.

A nurse is preparing to administer a rapid-acting insulin. Which medication would the nurse most likely administer? insulin lispro insulin glargine insulin detemir isophane insulin suspension

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.

What type of insulin will most likely be administered intravenously to a client with a blood glucose level over 600 mg/dL (33.33 mmol/L)? regular insulin lente insulin NPH insulin ultralente insulin

regular insulin Explanation: Regular insulin has rapid onset of action and can be given via IV. It is the drug of choice for acute situations, such as diabetic ketoacidosis. Isophane insulin (NPH) is used for long-term insulin therapy. Lente insulin is an intermediate-acting insulin. Ultralente insulin is a long-acting insulin.

The nurse is caring for a client taking insulin. The nurse realizes the client is experiencing symptoms of hypoglycemia when the client displays: increased pulse rate and fruity smelling breath. decreased respiratory rate and hot, dry skin. increased thirst and increased urine output. weakness, sweating, and decreased mentation.

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.