ATI Pharm Endocrine System Test, ATI Diabetes Mellitus Management, diabets
A nurse is teaching a client who was recently diagnosed with type one diabetes mellitus how to check blood glucose levels. Which of the following instructions should the nurse include in her teaching?
1. "Blood can be smeared from the fingertip onto the test strip." 2. "Use a syringe and needle to collect and transfer blood to the test strip." *3."To collect a sample for testing, hold the test strip next to the blood on the fingertip."* **This allows the blood to flow over the reagent pad until the amount of blood on the strip is adequate. A sample that is too small can result in falsely low readings.** 4. "Use a capillary tube to collect and transfer the blood from the fingertip."
A nurse is teaching a client who has type one diabetes mellitus about the peak time of neutral protamine hagedorn (MPH) inulin. Which of the following statements by the client indicates an understanding of the teaching?
1. NPH insulin peaks in 1-5 hours Regular insulin has an onset of 30 to 60 min, peaks in 1 to 5 hr, and lasts up to 10 hr. 2. NPH insulin is peakless Insulin glargine has an onset of 70 min, it is peakless, and it has a duration of 24 hr *3. NPH insulin peaks in 6-14 hours* *NPH insulin has an onset of 60 to 120 min, peaks in 6 to 14 hr, and has a duration of 16 to 24 hr.* 4. Insulin peaks in 12-24 hours Insulin detemir has a slow onset, peaks between 12 and 24 hr, and has a duration that varies with the dosage.
A nurse is reviewing self-administration of insulin using a pre-filled pen with a client who started using the pen the previous week. The client asks what can be done to help reduce injection pain. Which of the following instructions should the nurse give the client?
1.Agitate the syringe slightly before injection. 2. Store the pens with the needle pointing upward. 3. Inserting the needle rapidly minimizes injection pain. *4. Keep the pen at room temperature for a few minutes.* *Injecting room-temperature insulin is less painful than injecting cold insulin.*
fasting plasma glucose level
>126 mg/dL
0820
A nurse administers pramlintide at 0800 to a client who has type 1 DM. At which of the following times should the nurse expect the drug to exert its peak action?
Hypotension
A nurse at a provider's office is assessing a client who has been taking hydrocortisone for adrenal insufficiency. The client reports fatigue and feeling overwhelmed by personal responsibilities. Which of the following findings should the nurse identify as an indication the provider might need to increase the client's dosage?
Beta blockers
A nurse is caring for a client who is about to begin insulin glargine therapy. The nurse should identify the need for additional precautions because the client also takes which of the following types of drugs?
Urine output
A nurse is caring for a client who is taking desmopressin. The nurse should make which of the following assessments to evaluate the drug's effectiveness?
Skip the dose
A nurse is caring for a client who takes repaglinide 15 to 30 min before each meal to treat type 2 DM. The client asks, "If I skip a meal, what should I do?" Which of the following responses should the nurse make?
"We will use a different spot for injection each time we give the medication."
A nurse is educating the parents of a child who has a new diagnosis of Prader-Willi Syndrome (PWS) and has been prescribed somatropin. Which of the following statements by a parent indicates understanding of the teaching?
Obtain weight measurements daily Report weakness or palpitations Have blood pressure checked regularly
A nurse is providing teaching to a client about taking fludrocortisone to treat adrenocortical insufficiency. Which of the following instructions should the nurse include?
Inject the drug subcutaneously Expect the peak effect in 2 hr Use the drug as a supplement to an oral hypoglycemic
A nurse is providing teaching to a client who is about to begin exenatide therapy to treat type 2 DM. Which of the following instructions should the nurse include?
Expect life-long therapy with the drug
A nurse is providing teaching to a client who is about to begin levothyroxine therapy to treat hypothyroidism. Which of the following instructions should the nurse include?
Eat more iron rich foods
A nurse is teaching a client about acarbose therapy to treat type 2 DM. Which of the following instructions should the nurse include?
Avoid drinking alcohol
A nurse is teaching a client who has a prescription for glipizide therapy to treat type 2 DM. Which of the following instructions should the nurse include?
Renal impairment
A nurse should recognize that a provider will prescribe a lower dose of sitagliptin for a client who has type 2 DM and who also has which of the following?
Alpha-glucosidase inhibitors
Class of antihyperglycemic agent that delays the digestion and absorption of carbohydrates and decreases a postprandial increase in blood glucose. The advanges are that it inhbitis tart posprandial glucsoe, and their effects are no systemuc, Also, this type of agen does not depend on the presence of insulin at all. it can cause gi side efefecs. These medications can be used as monotherapy of in combinatoion with a sulfonylurea. Example:acarbose and miglitol
Excerise and activity orecautibs
Clients whose blood glucose leves tat are greater than 250 mg/dl should regrain from exverise until thereivre levels are closer to the expected regernce range. Tell clients who take insulin that they are more lilely to experience hypoglucemeia with activiyy -teach all cleients about proper footwear,avoidng exercise in extreme heat of cold,inspection their feet after exervise, adnd avoidung activiuy during periods of poor metabolc control -teach clients about habing snakes and flucose treplacement prior to dn druing exerivse to prevent hypoglucemia -moritr glucose propr tp during and after exxervise
insulin pumps
Continuous subcutaneous infusion Battery-operated device Connected via plastic tubing to a catheter inserted into subcutaneous tissue in abdominal wall Potential for tight glucose control -insulin oump therapy is prescribed for clients who have type 1 diagetes who require contiunous insulin replacemtn, some clients who have type 2 diabets are insulin dependent due to poor beta cell funtion in the pancreas can also benefit from insulin pumps. when caring for a cleint who uses a pump change the needle or catheter used to attach the pump every 1-3 days. Rotate needle sites and keep them at least one inch apary. It is acceptable to remobe the pump for short amounts of time, shuch as showing. An unsulin pump works by delivering a basal rate of reguluar insulin all day, woth the client calculation additinal insulin needs vased on meal.s Carb couting is a common methond client used to determine how much additional insulin to take There are risk of malfuntion, including low battery oiwer, occlusion of tubinh or needs, or lack of insulin in the ppump. If any of these problems iccure tand the client is not away of the the risk of dka increases . Insulin pumps only deliver regular rapid- acting insuling, usualy at the atrate of 1u per hour so the effects of disconnection form a pump occure quite rpaidly. There us akso a higher risk of hypoglycmeia in clients cont reving insulin because their basal glucose levels ten to decrease over time and they are not alwayas aware
Type 1 diabetes
Diabetes of a form that usually develops during childhood or adolescence and is characterized by a severe deficiency of insulin, leading to high blood glucose levels.
A nurse is caring for a client who has type one diabetes mellitus and reports feeling anxious and having palpitations. The glucometer reads 50 mg/dL. Which of the following actions should the nurse take?
Give the client 4 oz of apple juice. After confirming hypoglycemia, the nurse should give the client 15 to 20 g of a rapid-acting, concentrated carbohydrate source, such as 4 to 6 oz of fruit juice, 8 oz of skim milk, 1 tbsp of honey, or commercially prepared glucose tablets per package instructions.
A nurse is caring for a client who has type one diabetes mellitus and is in need of a long acting insulin prep. The nurse anticipates receiving a prescription for which of the following insulins?
Insulin glargine : Long-acting insulin, such as insulin glargine, is intended to provide basal glucose control. The dosage is typically once daily at the same time each day.
A nurse is teaching a client who has a new diagnosis of type two diabetes mellitus about metformin. The nurse should explain that this type of medication works by which of the following mechanisms?
Reducing hepatic glucose production. Biguanides reduce hepatic glucose production while increasing insulin action on muscle glucose uptake.
Combination therapies
There are some oral antidiabetic medications that are combination products developed to make it easier for clients to adhere to therir medication regimens when more than one medication is needed. Examples: metfromin & glyburide, Metformin & glipizide, and metformin & rosiglitazone
Medical nutrition therapy (MNT)
Use of specific nutritional therapies to treat an illness, injury, or condition.. Helps clients learn to incorporate good dietary choices into everyday life to promote weight looss as needed and to maintain glucose control. This must be individualiszed tfor each client. One sustem is based on 3 fpood grouos carbs, meet or meat substiute, and fat. Anotehr incorpotrates 6 groups: bread/starvh, betables,milk,meat,fruid and fat
Hydrocortisone
When considering replacement therapy options for a client who has chronic adrenocortical insufficiency, a nurse should recognize that the provider will choose which of the following drugs?
Glucagon
Which of the following drugs should a nurse have available for a client who is experiencing insulin toxicity?
Diabetic , ketoacidosis
a complication most often developed in clients who have type1 dianbgetes is characterized by hyperglucemia,ketones, in the urine, increased respiratory rate, and fruity breath oder, blood glucose levels are typically greater than 300mg /dl it is a medical emergency that warents imemeidate treatment
metabolic syndrome
a group of metabolic conditions that are associated with an increased risk of type 2 diabetes and cardiovascular disease. It is defined as the presence of any 3 of the following : abdominal obesity, elevated triglycerides, low hdl cholesterol, hypertension, and impaired fasting glucose
treating hypoglycemia
check clients capillary blood glucose level. Give 15-20 grams of rapid active concentrated carbohydrate (4-6ox fruit juice, 8 oz skim milk, 1tbsp honey, commercially prepared flucose tabs_ Retest in 15 mintues. If bg is < 70-75 mg/dl retreat and recheck . Onmce stableized make sure the client consumes a snake that contains,protein,and carbs if thep clients next meal is > 1 hours
Thiazolidinediones
class of antihyperglycemic agents that reduce insulin resistance. increases the celluar respinse to insulin by decreassing insulin resistance. This results in increased glucose uptake and decreasecd glucose production. The primary med is pioglitazone, which can be used alon or in combonation with metfromine, It is well tolerated but may reduce the effectiveness of oral contraceptes and shoul be used cautiously in clients who have heart failure
hyperglycemia
elevated blood glucose level due to impaired insulin secretion action or both cane balso be caused by genetic disorders disease of the pancreas,enocrinopathies,medications, infections, and immmune disoirdes It is in conjustion with polyuria,polydispia,polyphagia,nausea,fatigue,and blured vision
polyphagia
excessive hunger
polyuria
excessive urination
other injectable antidiabetic medication
exenatide in an incretin mimetic mediction for treating type 2 diabes. This med is prescribed alone or as combination therayp who are already taking metformin, a sulfonylurea, or both .Risks include hypoglucemia nd delayed gastric emtyuing. Most clients experivnce some weight loo which is and advangtage compatred to insulin therapy. This med works in severay locations of the body to promote better flucose control. IT slows gastruc empyting, stimulates glucose- dependent release of insulin, and inhibits postpradial realease of glucagon and suprpresses appetities. Adverse effects inclide hypoglycmeia, nauea, and pancreatitis. 2. Pramlintide is an amylin mimetic medication used to supplemnt the effects of insulin in clients who have type 1 or 2 diablets. IT helps reduce postpradial glucose by delaying gastric empyting and suppresses glucagon secreation. It aslo helps increase feelings if satiety thuse heloing to redduce caloric intake. IT is recommended for supplementing mealtime insulin in clinets who have type 1 & 2 diabetes. It can cause nausea, hypoglycemia when combination with insulin, and various medication interaction because of the effect of delayed gastric emotying
What increases glucose levels
exercise -illenss and infection (cleints who are hospitaizled are prescribed specialised diets may be at risk for hypoglycemia. Preoperative clients are typicawlly NPO prior to surgery and this can cause hypoflycemia) -stress (the release of hormones during stress in addition to changes in daily toutine and can raise glucose levels)
hyperglycemiac-hyperosmolar state (HHS)
formely called nonketotic hyperglycemia hyperosmolar coma- is a medicdal emergency more common in clients who have type 2 diabes and characterized by severe hyperglycemia, only slight or non ketosis abd profoubd dehydration. Blood glucoose levels with HHS are typcally greater than 600mg/d;
Regular or short-acting insulin
has an onset of 30-60 minutes, peaks in 1-5 hours and lasts up to 10 hours. It is administered before meals to control postprandial hyperglycemia, inject sq to ensure basal glycemic control, and may be insused iv in emergency situations
insulin
hormon secreated by the beta cells of the pancrease in response to glucose levels in the blood. Insulin secreation is also prompted by amino acids, fatty acids, and ketone bodies. Insulin helps the body use and store energy. insufficient or absent insulin in the body decreases the metabolisim of complex molecules, which results in the classic manigestation of uncontroled diabtes
Microvascular complications
including retionoparthy,neuropatyh, nephropathy- are dye to hyperglycemia induced thickening of retinal and flomerular beassement membranes. It reuslts from the alterations in small blood bessels that supplu tisses and organs. Teionpaty affects vision over time and can lead to partial or complete loss of svision. Nephroopathy affeects the functions of the kidsnets over tiem and can lead to renal failure. Neuropathy can cause autonomic and sensory problems. Autonomic neuropathic changes lead to gastrointestinal disturbances, bladder dysfunction, postural hypotension,, and sexual dysfuntion. Sensory changes associated with neuroppathy can cause carpal tunnel syndrome in the hands and paresthesia or lack of sensation in the feet. It is importatin to screen for neuropatich complications routinely in cleints who have duabestes and to refer them to specialtes such as ophthamology, podiatry,gastroenteroy,and urology as warranted
Intermediate acting insulin
inteested for once or twice a day dosing tocontrol blood glucose levels. Thiss type of insulin has a delayed action which makes it less effective for mealtime increases in blood glucose levels. Neutral proamine hagedorn (NPh) insulin falls into this category. NPh insulin has an onset of 60-120 minutes, peaks in 6-14 hours and has a duration of 16-24 hours
rapid and short acting insulin
intended for use in managing postpradnial increases in blood glucose. This type of insulin should be uses with intermediatie or long acting agent to insure optioaml blood glucose controle
Long acting insulin
inteneded to provide basal glucose control. The dosage is typically once daily at the same time each day. Exp: are insulin gargine and insulin detemir. Insulin glargine has sian inset of 70 mins, is peakless, and has a duration of 18-24 hours. Because the meidcatione xerys a steady effect with no peak. It carries a risk of hypoglycemia. Insulin detemir has a slow onset peask betweenm 12-24 hours and has a duratuion that varies with the dosage
Hypoglucemia
low blood glucose sugar less than 70 mg/dl. It can result from overtreatnmebt with neducatuib, unplanned physical activity, nutritoanl changes, and other factire. It is characterized by pallor,remor,diaphoresis(sweathing) palpitations, hunger, visual disturbances, weakness, paresthesias, confusion, agitation,coma, and death
infections
of the skin,urinary tract,and vagina are common in clients who have diabetes and slow to heal, Another common development is ulcers of the extremities that are also slow to heal
islets of langerhans
pancreatic cells responsible for producing insulin,glucagon,and somatostatin
Pregnacny- related complications
pregent clients who have typle 1 diabetes have a higher rusk of perinaly infany mortality and congenital anomalies. Pregnant clienets who develop getational diables are at risk for large birthweight babies, perinatal hypoglycmeia , and hyoertensive disorders. Untreated maternal hyperglycemia can result in spontaneous abortion and increased neonatal mortality
Beta cells
produce insulin; therefore when all the beta cells are destroted the body cannoy produce insulin to meet ongoing physiolocial mneeds
excerise and activiey
reduced blood glucsoes levels by promoting the uptake of glucose by active muscle cells and al making beter use of insulin
insulin resistance
reduced effectiveness of insulin in lowering blood glucose levels
5 step orivess type 2 diables
step 1- implement diet and exervise therapy step 2: initate therapy with one oral hypoglycemic. Medication choive deponds on body composition and severity of hyperglycemia step 3: treat with two oral hypoglycemics, preferabily from different classes, to mazimize tgheir benigits Step 4: treat with 2 oral hypoglycemics or one oral hypoglycemic plus insilin step 5: terat with insulin alone
oral hypoglycemics
stimulate insulin secretion from pancreatic cells in non-insulin-dependent diabetics with some pancreatic function generallyy prescribed forclients who have type two diabes and cannot achive good glycemiac control with diet and exervise alone
diabetes teaching
teach clients to recongize the manigestation of hypo-and hyperglycemia. Encourage them the call their provider with any concers Discuss information about obtaing medication, how to storre insuline, and the imporatnce of sharos contains for needle disposal. REview theprevention,detection, and management of chron complications associated with diabites, EMphazide the importance of goot and skin, and dental care. Discise the risk factor reduction, problem solbing,goal setting and behavioral changes, improving glucose control through management should be a goal for a clients who have diabets. Demonstrate the use of medication and monitroing supplies and methods. For females of childbeaing age, explain the implications of pregnancy explain the various systems, inclding exhange list, glycemic index and my plate to help clients acheive a health balaced diet that meets their indibudal needs. discuse the relationship between diet and excerise
Meglitinides
work by increasing insulin secreation by the beta cells of the pancrease. These medication tarfet postprandial glycemia nd may cause hypoglycemia if not taken in conjution with good. Thesee medications are approphed for monotherapy or in combination with metfrom or thiazolidinediones. Repaglinide and nateflinide are examples
Sulfonylureas
work by isncreasing insulin secreation by the beta cells. These meidcation cause causes weight gain and hypoglycemia. CAn be uses as monotherapy or in comination with insulin, metformin, thiazolidinediones, or alpha- glucosidease inhibtiros, Common medication names include glyburide, glipized and glimpermise
Combination/mixed insulin
*Commercially prepared premixed combinations of insulin are typically composed of intermediate-acting and short-acting insulin.. The numbers indicatie the percentage of each type of insulin. EXP humulin 70/30 contains 70% NPH insulin and 30% refular insulin. Premized insulin has the same risks,benegits, and effects they type of insulin it contains
Insulin pens
-convenient for clients who need only one type of insulin at a time, who are caoable of manageing their diabete , and who have neem trained in their proper use.
postprandial plasma glucose
200mg/dl of higher during an oral glucose tolernce test
type 2 diabetes
Diabetes of a form that develops especially in adults and most often obese individuals and that is characterized by high blood glucose resulting from impaired insulin utilization coupled with the body's inability to compensate with increased insulin production.
rapid acting insulin
these meidication have an onset of 15 minutes with a peak anywhere from 30-2.5 hours and a duration between 3-6 hours. This type of insulin is mosy often given right before meals. Examples: insulin lispro, insulin aspary, and insulin glulisine
Dipeptidyl Peptidase-4 Inhibitors
work by augmentin naturally occuring incretion hormones, which promote the release of insulin a nd decrease the secretion glucagon. The result is reduced fasting and postprandial glucose levels. Example: sitagliptin
fasting blood glucose level
70-110 mg/dL
A nurse is teaching a client who has type one diabetes about the use of an insulin pump. Which of the following information should the nurse include in the teaching?
1. The pump may disconnect the pump for short periods of time such as bathing and swimming. 2. Insulin is injected intermittently based on the client's glucose level 3. The pump uses intermediate-acting insulin. *4. The risk for developing DKA can be increased with the use of an insulin pump* Malfunction of the pump from low battery power, occlusion of tubing or needles, or lack of insulin in the pump increases the risk of DKA, particularly if the client is not aware of it.
Sore throat, joint pain, bradycardia, and rash
A nurse is caring for a client who is about to begin taking propylthiouracil (PTU) to treat hyperthyroidism. The nurse should instruct the client to report which of the following adverse effects?
polydispia
excessive thirst
gestational diabetes
a form of diabetes mellitus that occurs during some pregnancies
Weight gain
A nurse is caring for a client who is taking pioglitazone to treat type 2 DM. The nurse should monitor for which of the following findings?
uneexplaneding weight losss
cause random plasma glucose of 200 mg/dl or higher
nephropathy
disease of the kidney
A nurse is reviewing he results of routine lab test performed as a part of a client's annual physical examination. Which of the following values indicates a fasting blood glucose measurement that is outside of the expected reference range?
118 mg/dL This result exceeds the expected reference range for a fasting blood glucose measurement, which is generally between 74 and 106 mg/dL.
Recent myocardial infarction
A nurse is assessing a client who has a new prescription for levothyroxine. The nurse should identify which of the following findings as a contraindication for this drug?
ALT, LDL
A nurse is caring for a client who is about to begin taking pioglitazone to treat type 2 DM. The nurse should explain to the client about the need to monitor which of the following laboratory values?
Urine calcium and blood glucose
A nurse is caring for a client who is about to begin taking somatropin. The nurse should explain the need to monitor which of the following laboratory values?
Biguanides
work by reducing hepatic glucose production while increasing insulin action on muscle glucose uptake. These meds can cause gi side effects, vitamin b12 and folic acid deficiecies, and lactic acidois. There are withhelp before diagnostic test involving radiographic contrast medica. Biguanides can be used as monotherapy or in combination with insulin, sulfonylureas, non- sulfonylurea sacretagogues, or thiazolidinediones. They have been used for clients who have metabolic syndrome and polycystic ovarian syndrome. Example : metformin
Lactic acidosis
A nurse is caring for a client who is taking metformin to treat type 2 DM and reports muscle pain. Which of the following adverse reactions should the nurse suspect?
Perform a fingerstick blood glucose check
A nurse is speaking with a client who is taking glipizide to treat type 2 DM and has called to report feeling shaky, hungry, and fatigued. Which of the following actions should the nurse instruct the client to take?
Acute renal failure
A nurse is caring for a client who is taking metformin and is scheduled to undergo angiography using iodine-containing contrast dye. The nurse should identify that an interaction between metformin and the IV contrast dye increases the client's risk for which of the following conditions?
Hypothyroidism
A nurse is caring for a client who is taking PTU and reports weight gain, drowsiness, and depression. The nurse should identify that the client is experiencing which of the following adverse reactions to the drug?
Lipohypertrophy
A nurse is teaching a client about self-administering regular insulin. The nurse should instruct the client to rotate injection sites to prevent which of the following?
Administer pramlintide before meals
A nurse is teaching a client who has a prescription for pramlintide therapy to treat type 1 DM. Which of the following instructions should the nurse include?
macrovascular complication
include coronary artery disease, cerebrobascular accident, and periphearal vascualar diseas. They resuly from the alterations in large blood vessles. It is important to screen for vascular complications routinely in clients who have diabetes and to refer them to specializeds such as cardiology warranted. MAcrovascular complications increase the risk of early death in clients who have diabetes
