Ch- 41 Diabetes

A client receives a dose of insulin lispro at 8 AM. The nurse would be alert for signs and symptoms of hypoglycemia at which time?

Between 8:30 AM and 9:30 AM

A client, being evaluated for diabetes, asks how a blood glucose test is used to diagnosis this disease. What is the nurse's best response?

"A fasting blood sugar result of 126 mg/dL (6.99 mmol/L) or more on two separate occasions is diagnostic of diabetes."

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."

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."

A client with type 2 diabetes presents at the clinic for a routine follow-up appointment. The client asks the nurse whether he or she can take the herbal supplement ginseng. What is the correct response by the nurse?

"It increases the risk for low blood glucose levels."

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."

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."

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

Oral anti-diabetic agents can be used in various combinations for what purpose?

Additive effects

A patient has been prescribed acarbose. Which of the following interventions should the nurse perform to promote an optimal response to the medication?

Administer the drug with the first bite of the meal.

Which strategy will NOT increase the therapeutic effect of insulin?

All insulin should be stored in a refrigerator but never frozen.

The following patients are prescribed metformin. Which patient is likely at the greatest risk of having an adverse reaction to metformin?

An alcoholic patient

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 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.

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

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.

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

Which is the best indicator of overall diabetic control?

Glycosylated hemoglobin levels

The nurse is explaining the action of exenatide to a patient. Which would the nurse include?

Increase in insulin resistance

When describing the effects of incretins on blood glucose control to a group of students, which would an instructor include?

Increases insulin release

A client is receiving acarbose. What would the nurse incorporate into the teaching plan for this client about the action of the drug?

Inhibits an enzyme to delay glucose absorption

A nurse must recognize the duration of insulin so as not to cause harm to the client with administration of the improper type of insulin. Which insulins are rapid acting? (Select all that apply.)

Insulin aspart (NovoLog) Insuline glulisine (Apidra)

example of long-acting insulin

Insulin glargine

A nurse must recognize the duration of insulin as to not cause harm to the client with administration of the improper type of insulin. Which insulins are long-acting insulin? (Select all that apply.)

Insulin glargine (Lantus) Insulin detemir (Levemir)

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.

As a diabetic educator, the nurse is teaching a newly diagnosed diabetic client about aspects of the disease process. What would the nurse tell the client about the body's control of glucose?

It is related to fat and protein metabolism

The nurse who has admited a client with diabetic ketoacidosis should look for what assessment findings that are consistent with this diagnosis? (Select all that apply.)

Ketones in the urine Flushed, dry skin

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

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

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.)

Orange or other fruit juice Glucose tablets Hard candy

The nurse walks into the room of a client with type 1 diabetes and finds the client pale and diaphoretic. The client reports a headache and being hungry. Immediately, the client is unable to talk. What is the nurse's immediate intervention for this client?

Place glucose gel between the gums and cheek.

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

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.

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.

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

What hormone, secreted with insulin, increases satiety and suppresses glucagon secretion?

amylin

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

A client has been noncompliant with the diabetic medication regimen and develops diabetic ketoacidosis. Which would the nurse assess?

deep respirations

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

The nurse is caring for a client who is taking glyburide as treatment for type 2 diabetes mellitus. The health care provider 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?

hyperglycemia

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

When teaching a client about insulin administration, the nurse would instruct the client to administer insulin aspart at which time?

immediately before a meal

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

The nurse is caring for a postoperative client whose diabetes has been well controlled on acarbose. The client is not allowed to take anything orally following complications of abdominal surgery and is receiving high-glucose total parenteral nutrition via a central IV line. What medication can the nurse administer intravenously to control the client's blood glucose level?

regular insulin

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

The nurse is conducting a class for newly diagnosed adult diabetic patients. What would the nurse educate the patients about?

the disease

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

A male client is to begin glyburide (Diabeta) for type 2 diabetes. Before the drug therapy begins, a priority action by the nurse will be to assess the client's:

use of alcohol

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.

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?

Avoid drug administration in the case of a skipped meal.

A client is prescribed sitagliptin. The nurse would expect to administer this drug by which route?

oral

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 nurse is providing client education to a 13-year-old girl who was just diagnosed with type 1 diabetes mellitus. Which statement by the client will alert the nurse that special instructions regarding insulin are necessary?

"I am on the middle school track team."

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?

"I must take this medication one hour before I eat."

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

Which HbA1c result would indicate that a client's diabetes is under good control?

7%

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.

When planning diabetic screenings, which populations should receive the nurse's priority? Select all that apply.

Black clients Native American clients Hispanic immigrant clients

What outcome would best indicate the nurse's teaching of a client newly diagnosed with diabetes was effective and that drug therapy is appropriate?

Blood glucose level is stable with no diabetic complications.

The nurse is interviewing a client who was diagnosed with type 2 diabetes four months ago. The client does not records glucometer readings but reports no concerns. What laboratory test does the nurse anticipate the health care provider will order for this client?

HbA1c

When administering insulin, what would be most appropriate?

Insert the needle at a 45-degree angle for injection.

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 Lethargy Impaired mental functioning

A female client is prescribed metformin to decrease her blood glucose levels associated with diabetes mellitus type 2. Which statement accurately describes the action of metformin?

It decreases intestinal absorption of glucose and improves insulin sensitivity.

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.

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

Which would be least appropriate when administering insulin by subcutaneous injection?

Massaging the site after removing the needle

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.

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 client is admitted to the intensive care unit with diabetic ketoacidosis. The nurse knows that the client will be placed on an intravenous insulin drip. The only type of insulin that can be administered intravenously is:

Regular

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.

Which medication would a nurse identify as a noninsulin injectable antidiabetic drug?

exenatide

A nurse instructs a client who is elderly to eat within 30 minutes of the administration of which antidiabetic drugs to prevent hypoglycemia?

glyburide

A nurse is preparing to administer an insulin that is clear. Which insulin would the nurse most likely administer?

humulin R

After teaching a group of nursing students about insulin, the instructor determines that the teaching was successful when the students identify that insulin is produced by which organ in the human body?

pancreas

A student asks the nursing instructor what insulin has the quickest therapeutic effect once administered. What would be the best response?

Regular (Humulin R)

The nurse is caring for an adolescent newly diagnosed with type 1 diabetes. The client says, "I can't believe I'm going to spend the rest of my life sticking myself with needles." What future possibilities for insulin delivery can the nurse share with this client? Select all that apply.

implantable insulin pump insulin patch inhaled insulin

The nurse is caring for a pregnant client diagnosed with pregnancy-induced diabetes. What antidiabetic agent is best suited for administration to this client?

insulin

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?

insulin glargine

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?

late afternoon

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