PHARM CH 38 PREPU

Which would be least appropriate when administering insulin by subcutaneous injection? a. Massaging the site after removing the needle b. Inserting the needle at a 45-degree angle c. Using a 25 gauge 1/2-inch needle d. Injecting the insulin slowly

a. Massaging the site after removing the needle Gentle pressure should be applied to the injection after the needle is withdrawn. Massaging could contribute to erratic or unpredictable absorption.

The nurse is preparing to administer 20 units of NPH insulin to a client. Before administering the medication, the nurse should implement which intervention? a. Assess the client's understanding of diabetes. b. Massage the chosen injection site. c. Assess the client's urine for the presence of glucose. d. Have a colleague confirm the dosage.

d. Have a colleague confirm the dosage. Before administering insulin, client safety requires that two nurses always check the dosage. Assessing the client's understanding of the disease may or may not be appropriate or necessary at this time. Injection sites are not massaged before administration. It is not necessary to assess urine for the presence of glucose.

A nurse is caring for a client with elevated blood glucose levels who is to receive alpha-glucosidase inhibitor drug therapy. The nurse understands that this therapy would be contraindicated if the client had which condition? Select all that apply. a. cirrhosis b. colonic ulceration c. type I diabetes d. chronic intestinal diseases e. severe heart failure

a. cirrhosis b. colonic ulceration d. chronic intestinal diseases

What instructions should the nurse give to a client with type 2 diabetes who has been switched from glyburide to repaglinide? a. "Repaglinide rapidly stimulates insulin production, so you need to eat soon after taking the medication." b. "Repaglinide has a greater effect and is longer lasting, so you'll be prescribed it every other day." c. "It is less potent, so you'll likely be prescribed a larger dose." d. "The two medications are fundamentally similar, but some clients respond better to one than the other."

a. "Repaglinide rapidly stimulates insulin production, so you need to eat soon after taking the medication." 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 neither more nor less potent, and the two medications are not virtually the same.

Aterm-6 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? a. Inspect the previous injection site for inflammation. b. Keep prefilled syringes horizontally. d. Do not administer insulin kept at room temperature. c. Check for symptoms of myalgia or malaise.

a. Inspect the previous injection site for inflammation. 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 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.) a. Watch the client draw up and administer her insulin. b. Assist the client in making menus that will meet the needs of both the client and the family. c. Instruct the client to go to the emergency department immediately if she develops a cold or upper respiratory infection. d. Reinforce instructions on dealing with hypoglycemia. e. Encourage the client to check her blood glucose every hour.

a. Watch the client draw up and administer her insulin. b. Assist the client in making menus that will meet the needs of both the client and the family. d. Reinforce instructions on dealing with hypoglycemia.

Insulin binds with and activates receptors on cell membranes. Once insulin-receptor binding occurs, the membranes become highly permeable to glucose. Which action does this enable? a. Storage of glucagon in the cells b. Entry of glucose into the cells c. Interruption of glucose movement across the membrane d. Release of glucagon from the cells

b. Entry of glucose into the cells After insulin-receptor binding occurs, cell membranes become highly permeable to glucose and allow rapid entry of glucose into the cells.

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? a. Diazoxide b. Glucagon c. Insulin lispro d. Regular insulin

b. Glucagon 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.

What is the expected action of sitagliptin on type 2 diabetes? a. It is a synthetically prepared monosodium salt. b. It slows the rate of inactivation of the incretin hormones. c. It blocks the S phase of the cell cycle. d. It inhibits hydrogen, potassium, and ATPase.

b. It slows the rate of inactivation of the incretin hormones. Sitagliptin minimizes the rate of inactivation of the incretin hormones to increase hormone levels and prolong their activity. Sitagliptin does not block the S phase of the cell cycle. Sitagliptin is not a synthetically prepared monosodium salt nor does it inhibit hydrogen, potassium, and ATPase.

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? a. Impaired glucose tolerance b. Widespread changes in the blood vessels c. Poor insulin injection technique d. Infection

b. Widespread changes in the blood vessels 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.

With what client should the nurse question the administration of human insulin? a. a client who has been living with type 1 diabetes for 20 years b. a client whose type 2 diabetes is controlled by diet and exercise c. a client who has been diagnosed with gestational diabetes d. a client with type 2 diabetes, controlled with oral antidiabetic agents, who has a systemic infection

b. a client whose type 2 diabetes is controlled by diet and exercise Insulin is recommended for treatment of type 2 diabetes in clients whose diabetes cannot be controlled by diet or other pharmacotherapeutic agents. If the diabetes can be controlled by diet, the pancreas is still functioning and releasing insulin. Human insulin can be used in clients with gestational diabetes or clients with type 1 diabetes of many years standing. The presence of an infection may require the use of insulin in a client whose diabetes is normally controlled by oral medications.

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? a. insulin lispro b. insulin glargine c. isophane insulin suspension d. insulin aspart

b. insulin glargine 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.

A client's current condition requires rapid reduction of blood sugar levels. Which type of insulin will have the most rapid onset of action? a. isophane (NPH) b. insulin lispro c. Humulin R d. isophane (NPH)

b. insulin lispro 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.

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? a. Administer the insulin to the client. b. Ensure a meal tray is available. c. Check the dosage with another nurse. d. Check the client's blood sugar again.

c. Check the dosage with another nurse. 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.

When describing the effects of incretins on blood glucose control to a group of students, which would an instructor include? a. Increases glucagon release b. Increases protein building c. Increases insulin release d. Increases GI emptying

c. Increases insulin release Incretins increase insulin release, decrease glucagon release, slow GI emptying, and stimulate the satiety center. Growth hormone increases protein building.

A client who has been prescribed metformin is scheduled to undergo diagnostic testing with the administration of parenteral radiographic contrast media containing iodine. What fact should direct the nurse's plan of care for this client? a. Insulin will be temporarily substituted for the metformin to address the risk of potential kidney failure. b. The client will be prescribed an extra dose of metformin to address the contrast media effect on the body. c. Metformin should be discontinued at least 48 hours before and after diagnostic tests that use contrast medias. d. The client needs to be encouraged to drink 1 to 2 L of water to flush the contrast media out of the kidneys.

c. Metformin should be discontinued at least 48 hours before and after diagnostic tests that use contrast medias. Metformin should be discontinued at least 48 hours before diagnostic tests are performed with contrast media and should not be resumed for at least 48 hours after the tests are done and tests indicate renal function is normal. None of the other options are required.

A patient at a health care facility has been prescribed diazoxide for hypoglycemia due to hyperinsulinism. What adverse reactions to the drug should the nurse monitor for in the patient? a. Epigastric discomfort b. Myalgia c. Tachycardia d. Flatulence

c. Tachycardia The nurse should monitor for tachycardia, congestive heart failure, sodium and fluid retention, hyperglycemia, and glycosuria as the adverse reactions in the patient receiving diazoxide drug therapy. Myalgia, fatigue, and headache are the adverse reactions observed in patients undergoing pioglitazone HCl drug therapy. Flatulence is one of the adverse reactions found in patients receiving metformin drug therapy. Epigastric discomfort is one of the adverse reactions observed in patients receiving acetohexamide drugs.

A client in the community is taking regular and NPH insulin to manage type 1 diabetes. What finding best demonstrates that the client's diabetes management is adequate? a. fasting blood glucose level of 80 mg/dL b. blood glucose of 120 mg/dL c. glycosylated hemoglobin (HbA1C) level of 6.1% e. absence of neuropathies

c. glycosylated hemoglobin (HbA1C) level of 6.1% HbA1C levels provide a 3-month average of glucose levels, which provides the best evaluation tool to measure the overall client response to the treatment plan. A value of 7% or lower is deemed adequate. Fasting and random blood glucose levels provide one-time points of data but cannot be extrapolated to determine the client's overall response to therapy. The absence of diabetic nephropathy does not necessarily show that the client's management program is meeting needs.

A client is receiving metformin therapy at a health care facility. The client is also prescribed glucocorticoids. The nurse would be alert for which adverse reaction due to the interaction of these two drugs? a. delay in gastric emptying b. increased hypoglycemic effect c. increased risk of lactic acidosis d. increased risk for bleeding

c. increased risk of lactic acidosis The nurse should observe an increased risk of lactic acidosis in the client as an effect of the interaction of metformin and glucocorticoids. Increased hypoglycemic effect is an effect of the interaction of sulfonylureas with anticoagulants, chloramphenicol, clofibrate, fluconazole, histamine H2 antagonists, methyldopa, monoamine oxidase inhibitors (MAOIs), salicylates, sulfonamides, and tricyclic antidepressants. Increased risk for bleeding is an effect of the interaction of oral anticoagulants with anti-infective drugs. Delay in gastric emptying is an effect of the interaction of anticholinergics with anti-infective drugs.

A client diagnosed with type 1 diabetes suddenly reports feeling weak, shaky, and dizzy. What should be the nurse's initial response? a. Administer 1 ampule of 50% dextrose intravenously. b. Have the client drink a 4-ounce (120-mL) glass of orange juice. c. Administer 10 units of regular insulin subcutaneously. d. Perform a blood sugar analysis.

d. Perform a blood sugar analysis. As long as the client is awake and verbally responsive, check the blood glucose level first. Hypoglycemia can make a client feel weak, confused, irritable, hungry, or tired, but assessment must precede interventions; this makes the other options inappropriate.