ch 38 blood glucose agents
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." Insulin appears to activate a process that helps glucose molecules enter the cells of striated muscle and adipose tissue. It also stimulates the synthesis of glycogen by the liver, promotes protein synthesis, and helps the body store fat by preventing its breakdown for energy.
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?
"The medication will peak in 3 hours."
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.)
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.
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.)
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.
A nurse is assigned to administer glargine to a patient at a health care facility. What precaution should the nurse take when administering glargine?
Avoid mixing glargine with other insulin.
As the nurse caring for a young child is diagnosed with type 1 diabetes (IDDM), you know that they become at high risk for what and you include assessment and management of this in their care plan?
Delayed growth and development
The nurse is caring for a client with diabetes and administered the client's scheduled dose of regular insulin and NPH insulin at 08:00. At 09:30 the nurse checks the client's blood glucose level, which is 140 mg/dL. What is the nurse's best action?
Document the finding and check the client's blood glucose level in one hour
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?
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.
The nurse is providing education to the parents of a child newly diagnosed with type 1 diabetes. What distinguishing characteristic of the disorder does the nurse include in the teaching?
Exogenous insulin is required for life. Type 1 diabetes will result in eventual destruction of beta cells, and no insulin is produced. Therefore, the client will require insulin supplementation (exogneous insulin) for life. The blood glucose level can only be controlled by diet in type 2 diabetes. In type 2 diabetes, oral agents can be administered. Type 1 diabetes is diagnosed in ages 4 through 20 years, not only in childhood.
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 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.
The nurse is preparing to administer 20 units of NPH insulin to a client. Before administering the medication, the nurse should implement which intervention?
Have a colleague confirm the dosage.
When administering insulin, what would be most appropriate?
Insert the needle at a 45-degree angle for injection. 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?
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.
What is the expected action of sitagliptin on type 2 diabetes?
It slows the rate of inactivation of the incretin hormones.
A client, who experienced hypoglycemia twice in the past week, eats one meal per day and snacks the rest of the day. What client education will the nurse provide for a client who reports regularly experiencing hypoglycemic symptoms?
Meals should be eaten at regular times. A regular dietary intake associated with the administration of insulin or oral hypoglycemic will prevent episodes of hypoglycemia. The client should limit alcohol consumption, but alcohol consumption does not contribute to hypoglycemia. The client should not increase caloric or protein intake. The client should coordinate exercise with her dietary intake, but dietary intake is not the cause of the hypoglycemia.
A nurse is caring for a patient with diabetes mellitus who is receiving an oral antidiabetic drug. Which of following ongoing assessments should the nurse perform when caring for this patient?
Observe the patient for hypoglycemic episodes.
A student asks the nursing instructor what insulin has the quickest therapeutic effect once administered. What would be the best response?
Regular (Humulin R) Regular insulin has the quickest onset of 30-60 minutes. PZI and ultralente have an onset of 4-8 hours. NPH has an onset of 60-90 minutes.
A nurse is working with a newly diagnosed diabetic client on understanding hypoglycemia and insulin reactions. Which action would be most important for the client to understand when planning the response to an insulin reaction?
Take an oral dose of some form of glucose as soon as possible.
Which condition must be met in order for glyburide treatment to be effective?
The client must have functioning pancreatic beta cells.
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?
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.
The nurse is working with a client who uses an insulin pump for management of type 1 diabetes. The nurse should remind the client that the needle on the pump needs to be changed how often?
every 1-3days
The nurse educator works at the diabetes clinic. When talking to a class of adolescent diabetics, the educator tells the students that the most recognized signs of diabetes are:
hyperglycemia and glycosuria.
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 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.
Rosiglitazone is being considered for the treatment of diabetes in an adult client. Before the initiation of rosiglitazone therapy, the nurse should review what laboratory work recently drawn?
liver enzymes Rosiglitazone has been associated with hepatotoxicity and requires monitoring of liver enzymes. Liver function tests (e.g., serum aminotransferase enzymes) should be checked before starting therapy and every 2 months for 1 year, then periodically. Platelets, d-dimer, and tests of renal function are less significant to the safety and efficacy of treatment.
Which would be least appropriate when administering insulin by subcutaneous injection?
massaging the site
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?
tachycardia
The nurse should include what information when educating a client prescribed insulin regarding the characteristics of hypoglycemia? Select all that apply.
the onset of symptoms/signs is sudden affected by increased emotion triggered by missing a regular meal
The nurse is instructing a client how to take a prescribed pramlintide. Which would be most appropriate?
"Give it by subcutaneous injection immediately before your major meals."
A 54-year-old male client is diagnosed with chronic renal failure and hyperglycemia. He asks if he can be prescribed sulfonylurea because it works well for his friend. If he were to be given sulfonylurea, this client's renal impairment may lead to what effect?
Accumulation and hypoglycemia Sulfonylureas and their metabolites are excreted mainly by the kidneys; renal impairment may lead to accumulation and hypoglycemia. They should be used cautiously, with close monitoring of renal function, in clients with mild to moderate renal impairment and are contraindicated in severe renal impairment.
The nurse is caring for a client who has been prescribed glyburide. Which factor, if identified in the client history, would cause the nurse to inform the health care provider of a contraindication to use?
Allergy to sulfonamides
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?
Detemir Insulin detemir cannot be mixed in solution with any other drug, including other insulins. Regular, lente, and lispro can be mixed.
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.
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.)
Headache Confusion Diaphoresis
The nurse admits a client with type 2 diabetes who takes metformin (Glucophage).The nursing diagnosis given is ineffective breathing pattern. What complication of the client's current drug therapy does the nurse believe the client is experiencing?
Lactic acidosis When taking metformin, the client is at risk for lactic acidosis, which causes hyperventilation, myalgia, malaise, GI symptoms, or unusual somnolence. Respiratory alkalosis, fluid overload, and hyperkalemia would be unlikely complications with metformin.
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 dosage w another nurse
The stress response triggered by illness will result in the increase secretion of what hormone? Select all that apply.
cortisol glucagon growth epinephrine Illness may affect diabetes control by triggering a stress response, resulting in increased secretion of glucagon, catecholamines, epinephrine, growth hormone, and cortisol and the presence of ketosis. Thyroxine, a thyroid hormone, is not affected.
When describing the effects of incretins on blood glucose control to a group of students, which would an instructor include?
increases insulin release Incretins increase insulin release, decrease glucagon release, slow GI emptying, and stimulate the satiety center. Growth hormone increases protein building.
The nurse is caring for a client who is taking insulin. The nurse suspects the client is experiencing hypoglycemia when the client displays what signs?
weakness, sweating, and decreased mentation. Symptoms of hypoglycemia include shakiness, dizziness or light-headedness, sweating, nervousness or irritability, sudden changes in behavior or mood, weakness, pale skin, and hunger
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?
blurred vision 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.
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 Metformin is classified as a biguanide. Miglitol is an alpha-glucosidase inhibitor. Tolbutamide is a first generation sulfonylurea. Glipizide is a second generation sulfonylurea.
The nurse admitted a 4-year-old child with type 1 diabetes mellitus. The nurse educates the parents that hypoglycemia can occur as an adverse effect of insulin. The nurse helps the parents to understand that in young children, hypoglycemia may manifest as what signs or symptoms? (Select all that apply.)
Irritability Impaired mental functioning Lethargy
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?
0645 With short-acting insulins like lispro, aspart, or glulisine, it is important to inject the medication about 15 minutes before eating.
A client diagnosed with type 1 diabetes suddenly reports feeling weak, shaky, and dizzy. What should be the nurse's initial response?
perform a blood sugar analysis
The nurse is interviewing a client who was diagnosed with type 2 diabetes four months ago. The client does not record glucometer readings. What laboratory test does the nurse anticipate the health care provider will order for this client?
HbA1c The nurse anticipates that the glycosylated hemoglobin (HbA1c) will be ordered for this client because it provides an average of the client's blood glucose level for the last three- to four-month period. It will also tell how well controlled the client's blood glucose is. A stat urine for glucose and an FBG in the AM will only indicate the client's current blood glucose level, not how well it is being controlled. An insulin level will not give the information needed to understand the client's control of blood glucose.
A client diagnosed with type 2 diabetes several months ago has presented for a scheduled follow-up appointment. Which stated behavior most clearly indicates that the client has established effective health maintenance?
The client frequently checks blood glucose levels.
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
hypoglycemia 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.
