Pharm PrepU chapter 41
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?
Glucagon
A client's current condition requires rapid reduction of blood sugar levels. Which type of insulin will have the most rapid onset of action?
insulin lispro
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?
"I'll plan to take my glyburide each night before I go to bed."
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?
"Insulin assists glucose molecules to enter the cells of muscle and fat tissues."
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?
"It stimulates insulin production, so you need to eat soon after taking the medication."
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?
"Please continue taking the medication and monitoring your weight. This is an expected outcome of this drug therapy."
What statement would be appropriately included in the teaching concerning type 2 diabetes?
"Regular exercise makes your body better able to use the insulin it produces."
What instructions should the nurse give to a client with type 2 diabetes who has been switched from glyburide (DiaBeta) to repaglinide?
"Repaglinide rapidly stimulates insulin production, so you need to eat soon after taking the medication."
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?
06:45
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?
126 mg/dL
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?
Assess the most recent hemoglobin A1C 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?
Check the dosage with another nurse.
A nurse should take what steps prior to administering insulin glargine (Lantus) to a client? Select all that apply.
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.
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?
Client's average blood glucose is above normal.
A nurse is caring for a patient with type 2 diabetes receiving a meglitinide. For which of the following conditions of the patient is meglitinides contraindicated?
Diabetic ketoacidosis
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?
Do not give pramlintide in the same site where insulin is administered.
When learning about type 1 diabetes, what would the student nurses learn is a distinguishing characteristic of this disease?
Exogenous insulin is required for life.
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?
Give oral fluids or candy.
After teaching a group of students about sulfonylureas, the instructor determines that the teaching was successful when the students identify which agent as a second-generation sulfonylurea? (Select all that apply.)
Glimepiride Glyburide
Which would a nurse identify as an example of a sulfonylurea?
Glyburide
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?
Glycosylated hemoglobin (HbAlc) levels
Which is the best indicator of overall diabetic control?
Glycosylated hemoglobin levels
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.)
Hard candy Orange or other fruit juice Glucose tablets
When describing the effects of incretins on blood glucose control to a group of students, which would an instructor include?
Increases insulin release
Which are risk factors for type-2 diabetes that a nurse should recognize in a client? Select all that apply:
history of gestational diabetes obesity impaired glucose tolerance
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?
Inspect the previous injection site for inflammation.
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?
Insulin is needed because the beta cells of the pancreas are no longer functioning.
A nurse is presenting an educational event at a local senior citizens' club about diabetes. What would the nurse tell the attendees at the event about diabetes?
It is a complicated disorder that alters the metabolism of glucose.
Which would be least appropriate when administering insulin by subcutaneous injection?
Massaging the site after removing the needle
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?
Metformin
What antidiabetic agent is approved for the nurse to administer to children 10 years old and older with type 2 diabetes?
Metformin
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?
Metformin does not cause hypoglycemia.
A client 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?
Metformin should be discontinued at least 48 hours before and after diagnostic tests that use contrast medias.
A client is prescribed sitagliptin. The nurse would expect to administer this drug by which route?
Oral
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?
Prepare a week's supply of syringes and refrigerate.
A student asks the nursing instructor what insulin has the quickest therapeutic effect once administered. What would be the best response?
Regular (Humulin R)
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 insulin
A nurse is preparing to administer an insulin that is clear. Which insulin would the nurse most likely administer?
humulin R
A nurse is preparing an in-service presentation for a group of staff members on diabetes. Which would the nurse include as the primary delivery system for insulin?
Subcutaneous injection
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?
Subcutaneous injection
The nurse in the emergency department receives a conscious client following a motor vehicle accident who has no known history of diabetes but whose blood glucose level is 325 mg/dL. What rationale does the nurse provide explaining this elevated blood glucose level?
The client's stress reaction likely caused an increase in blood sugar.
The nurse is conducting a class for newly diagnosed adult diabetic patients. What would the nurse educate the patients about?
The disease
A 35-year-old client has begun the administration of glyburide for treatment of diabetes mellitus type 2. The nurse caring for this client provides education regarding this medication. Which statement would NOT be an appropriate instruction for this client?
The medication should have a fixed dose which cannot be manipulated.
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?
U-10 (10 units/mL) insulin
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:
increasing insulin secretion from the pancreas.
A nurse is preparing to administer a rapid-acting insulin. Which medication would the nurse most likely administer?
insulin lispro
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?
liver enzymes
When considering the management of diabetic ketoacidosis (DKA), what type of insulin can be administered intravenously?
regular
After teaching a group of nursing students about antidiabetic drugs, the instructor determines that the teaching was successful when the students identify which as an example of a hormone mimetic? Select all that apply.
sitagliptin exenatide pramlintide
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?
the past 3 or 4 months
The nurse is caring for a client taking insulin. The nurse realizes the client is experiencing symptoms of hypoglycemia when the client displays:
weakness, sweating, and decreased mentation.
Which HbA1c result would indicate that a client's diabetes is under good control?
7%