Pharm Diabetes
The nurse is caring for a client who receives an injection of regular insulin before each meal. How many minutes before a meal should regular insulin be injected? a) 15 to 20 b) 20 to 30 c) 10 to 15 d) 30 to 45
d) 30 to 45 With regular insulin before meals, it is very important that the medication be injected 30 to 45 minutes before meals so that the insulin will be available when blood sugar increases after the meal.
During insulin teaching, when should the nurse advise the patient to administer insulin aspart (Apidra)? (Choose one) a) At bedtime b) Immediately after the meal c) 30 to 60 minutes before a meal d) Immediately before a meal
b) Immediately before a meal Insulin aspart (Apidra) is given immediately before a meal or within 5 to 10 minutes of beginning a meal.
The nurse is reinforcing teaching about acarbose (Precose) to a client with newly diagnosed type 2 diabetes. Which statement by the client indicates a need for further understanding? a) "I must take this medication one hour before I eat." b) "I will check my blood sugar at least three times a day while I am getting used to the medication." c) "I may experience some gas with this medication." d) "I will take this medication three times a day."
a) "I must take this medication one hour before I eat." Acarbose is given three times a day with the first bite of the meal because food increases absorption. It may cause GI effects such as abdominal discomfort, flatulence, and diarrhea. Clients should be taught to check their blood sugar frequently when first diagnosed to help determine if the medication is effective.
Which strategy will NOT increase the therapeutic effect of insulin? a) All insulin should be stored in a refrigerator but never frozen. b) Blood glucose levels should be monitored several times per day. c) Insulin should be administered in the subcutaneous tissue. d) Regular insulin should be administered 30 minutes before meals.
a) All insulin should be stored in a refrigerator but never frozen. Store opened vials of regular insulin at room temperature. Extra supplies are stored in the refrigerator, not the freezer. Extreme temperatures (<2°C or >30°C) should be avoided to prevent the loss of maximum function. Administer regular insulin with an insulin syringe into an appropriate subcutaneous site. Regular insulin is administered about 30 to 60 minutes before eating. To promote regular absorption, one anatomic area should be selected for regular insulin injections (e.g., the abdomen). Frequent monitoring of blood glucose by fingersticks and periodic determinations of hemoglobin A1C levels help determine the therapeutic effect of insulin and overall consistency of diabetic control.
A diabetic patient has just received an insulin pump. What would be important to include in patient teaching? a) Change tubing frequently. b) Have pump calibrated weekly. c) Watch for signs and symptoms of infection. d) Check blood glucose frequently.
a) Check blood glucose frequently. The device does have several disadvantages. For example, it is awkward, the tubing poses an increased risk of infection and requires frequent changing, and the patient has to frequently check blood glucose levels throughout the day to monitor response. The most important factor to teach a patient with an insulin pump is to monitor their blood glucose frequently. The patient does not need to have their pump calibrated weekly.
After teaching a group of students about the various insulin preparations, the instructor determines that the teaching was successful when the students identify that which type of insulin cannot be mixed with other types? a) Detemir b) Lispro c) Regular d) Lente
a) Detemir Insulin detemir cannot be mixed in solution with any other drug, including other insulins. Regular, lente, and lispro can be mixed.
A nurse at a health care facility is caring for a patient who has been prescribed insulin for the first time. Which preadministration assessment should be performed by the nurse before the first dose of insulin is given? a) General assessment of the skin b) Assess for hypoglycemic episodes c) Assess the dental health of the patient d) Assess the hearing ability of the patient
a) General assessment of the skin The nurse should perform a general assessment of the skin, mucous membranes, and extremities of the patient as a preadministration assessment before giving the first dose of insulin. The nurse need not assess for hypoglycemic episodes before administration of the first dose of insulin since the patient has not received any insulin or oral antidiabetic drugs. The nurse need not assess the dental health or the hearing ability of the patient as these are not pertinent to insulin administration.
During ongoing assessment of clients receiving insulin detemir (Levemir), the nurse assesses the client for symptoms of hyperglycemia that include which of the following? Select all that apply: a) Increased urination b) Increased thirst c) Abdominal pain d) Increased appetite e) Confusion
b) Increased thirst a) Increased urination c) Abdominal pain The symptoms of hyperglycemia include drowsiness, dim vision, thirst, nausea, vomiting, abdominal pain, loss of appetite, acetone breath, and excessive urination.
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? a) Give oral fluids or candy. b) Administer glucagon by the parenteral route. c) Administer the insulin via insulin pump. d) Administer oral antidiabetics to the patient.
a) Give oral fluids or candy. 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 patient receives 25 units of NPH insulin at 7 AM. At what time of day should the nurse advise the patient to be most alert for a potential hypoglycemic reaction? a) Late afternoon b) Bedtime c) After breakfast d) Before lunch
a) Late afternoon After an early morning dose of NPH insulin, the patient should be alert for a possible hypoglycemic reaction during mid- to late afternoon. The lengthy peak action time produces additional risks for hypoglycemic reactions.
The nurse is caring for a client who is taking glyburide as treatment for type 2 diabetes mellitus. The physician has added a corticosteroid to this client's medication regimen for treatment of a severe allergic reaction. The nurse knows that this drug combination may cause what adverse effect on this client? a) The client is at risk for hyperglycemia. b) The client will experience nausea and vomiting. c) The client will experience rash and fever. d) The client is at risk for hypoglycemia.
a) The client is at risk for hyperglycemia. Corticosteroids increase insulin needs so the client may develop hyperglycemia.
A patient has been prescribed acarbose. Which of the following interventions should the nurse perform to promote an optimal response to the medication? a) Notify the PHCP if the patient experiences unusual somnolence. b) Administer the drug with the first bite of the meal. c) Administer the drug with breakfast. d) Add an oral sulfonylurea with the drug.
b) Administer the drug with the first bite of the meal. The nurse should administer the acarbose drug to the patient with the first bite of the meal. The nurse needs to administer glyburide (Micronase) with breakfast. The nurse needs to add an oral sulfonylurea with metformin if the patient does not experience a response in four weeks using the maximum dose of metformin. Patients taking metformin may experience unusual somnolence, of which the nurse should inform the PHCP.
The nurse's assessment of a patient who has presented to the emergency department reveals hyperglycemia. Which type of insulin will have the most rapid effect on the patient's blood sugar levels? a) Regular b) Aspart c) NPH d) 30/70
b) Aspart Aspart has an onset of action of 5 to 10 minutes, making the most rapidly acting insulin. NPH, regular, and 30/70 all take significantly longer to have an effect on blood glucose levels.
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) Check the dosage with another nurse. c) Ensure a meal tray is available. d) Check the client's blood sugar again.
b) 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.
Meglitinides should be administered at what time? a) 30 minutes before the meal b) With the first bite of a meal c) 1 hour before the meal d) 1 hour after the meal
b) With the first bite of a meal Because meglitinides work quickly and do not stay in the body long, they need to be taken at each meal. By taking the medication at the time of the first bite, the possibility of a hypoglycemic episode is reduced. This allows flexibility for people who do not eat on the same schedule each day.
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? a) "I must give this insulin alone and not mix with other insulins." b) "I should not administer the insulin if it is cloudy." c) "The medication will peak in 3 hours." d) "The insulin is given only once per day, at night."
c) "The medication will peak in 3 hours." 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 nurse is preparing a teaching plan for a patient who is prescribed a meglitinide. What instruction should the nurse include in the teaching plan for the patient? a) Report respiratory distress or muscular aches. b) Use commercial weight-loss products with the drug. c) Avoid drug administration in the case of a skipped meal. d) Take the drug one hour before the meal.
c) Avoid drug administration in the case of a skipped meal. The nurse's teaching plan for the patient should instruct the patient taking meglitinides to avoid drug administration in the case of a skipped meal. The nurse should instruct the patient to take the meal within 15 to 30 minutes of administering the drug. The nurse should instruct the patient to report to the PHCP any instances of respiratory distress or muscular aches when administering metformin. The nurse should instruct the patient to avoid commercial weight-loss products, alcohol, dieting, and strenuous exercise programs unless approved by the PHCP.
A client receives regular insulin at 8:00 AM. The nurse would be alert for signs and symptoms of hypoglycemia at which time? a) Between 8:30 AM and 9:30 AM b) Between 2:00 PM and 4:00 PM c) Between 10:00 AM and 12:00 PM d) Between 12:00 PM and 8:00 PM
c) Between 10:00 AM and 12:00 PM 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 10:00 AM and 12:00 PM. If insulin lispro were administered, peak effects would occur in 30 to 90 minutes or between 8:30 AM and 9:30 AM. If insulin detemir were given, peak effects would occur in 6 to 8 hours, or between 2:00 PM and 4:00 PM. If NPH insulin were given, peak effects would occur in 4 to 12 hours, or between 12:00 PM and 8:00 PM.
The nurse is caring for a client who is taking a thiazide diuretic, a corticosteroid, and estrogens. The nurse understands that this client is at risk for what condition? a) Pulmonary hypertension b) Congestive heart failure c) Hyperglycemia d) Hypoglycemia
c) Hyperglycemia Renal insufficiency may increase risks of adverse effects with antidiabetic drugs, and treatment with thiazide diuretics, corticosteroids, estrogens, and other drugs may cause hyperglycemia, thereby increasing dosage requirements for antidiabetic drugs.
A nurse should monitor a client taking glimepiride (Amaryl) for which of adverse effects? (Select all that apply.) a) Edema b) Lactic acidosis c) Hypoglycemia d) Heartburn e) Nausea
c) Hypoglycemia d) Heartburn e) Nausea Adverse reactions associated with sulfonylureas, like glimepiride (Amaryl), include hypoglycemia, anorexia, nausea, vomiting, epigastric discomfort, weight gain, heartburn, and various vague neurologic symptoms, such as numbness and weakness of the extremities.
A nurse is instructing a patient in the administration of regular insulin by the subcutaneous route. Which strategy would the nurse suggest if the goal is to promote absorption of the regular insulin? a) Rotate injection sites by using the arm one day, the stomach the next day, and the thigh the day after and then repeating the cycle. b) Administer the medication 30 to 60 minutes after a meal. c) Select one anatomic area for regular insulin injections and then use serial locations within that area. d) Select one injection site for regular insulin injections and use it exclusively.
c) Select one anatomic area for regular insulin injections and then use serial locations within that area. To promote the absorption of regular insulin, one anatomic area should be selected for subcutaneous injections. Serial locations within that anatomic area are then chosen to rotate the exact injection site. Injection sites should not be rotated by using different anatomic areas each day, because this would substantially change the absorption of the insulin and the patient's blood glucose levels. Using one injection site regularly may lead to lipodystrophy. Regular insulin is administered about 30 to 60 minutes before eating a meal, not after.
A patient receives a dose of insulin lispro at 8 AM. The nurse would be alert for signs and symptoms of hypoglycemia at which time? a) Between 12 noon and 8 PM b) Between 10 AM and 12 noon c) Between 2 PM and 4 PM d) Between 8:30 AM and 9:30 AM
d) Between 8:30 AM and 9:30 AM 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 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) Regular insulin b) Insulin lispro c) Diazoxide d) Glucagon
d) 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.
During ongoing assessment of clients receiving insulin detemir (Levemir), the nurse assesses the client for symptoms of hypoglycemia that include which symptoms? (Select all that apply.) a) Diaphoresis b) Increased thirst c) Confusion d) Headache e) Increased urination
d) Headache c) Confusion a) Diaphoresis The symptoms of hypoglycemia include fatigue, weakness, nervousness, agitation, confusion, headache, diplopia, convulsion, dizziness, unconsciousness, hunger, nausea, diaphoresis, and numbness or tingling of the lips or tongue.
The nurse teaches the male client with type 1 diabetes that insulin needs vary depending upon certain conditions. The client requires additional teaching when he learns that his insulin needs may increase because of what condition? (Select all that apply.) a) Stress b) Anxiety c) Decreased food intake d) Fever e) Exercise
e) Exercise c) Decreased food intake Exercise and decreased food intake decrease insulin needs; fever, anxiety, and stress all will increase insulin needs for the client with type 1 diabetes.