Chapter 38 practice questions- PrepU
A student asks the nursing instructor what insulin has the quickest therapeutic effect once administered. What would be the best response? A) PZI (Humulin U) B) NPH (Humulin N) C) Regular (Humulin R) D) Ultralente (Humulin U Ultralente)
C) Regular (Humulin R)
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? A diagnosis of hypertension Increase in alkaline phosphatase Allergy to sulfonamides The ingestion of carbohydrates
Allergy to sulfonamides
A patient is diagnosed with type 1 diabetes. What distinguishing characteristic is associated with type 1 diabetes? It always starts in childhood. Oral agents can control blood sugar. Exogenous insulin is required for life. Blood glucose levels can be controlled by diet.
Exogenous insulin is required for life.
What should be the nurse's initial response when a client diagnosed with type 1 diabetes suddenly reports feeling weak, shaky, and dizzy? Administer 1 ampule of 50% dextrose intravenously (IV). Administer 10 units of regular insulin subcutaneously (sub-Q). Perform a blood sugar analysis. Have the client drink a 4-ounce glass of orange juice.
Perform a blood sugar analysis.
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? External pump Insulin pen Jet injector Subcutaneous injection
Subcutaneous injection
Glycosylated hemoglobin levels provide reliable evidence of blood glucose control. T/F?
True
What hormone, secreted with insulin, increases satiety and suppresses glucagon secretion? Aldosterone Amylin Anti-diuretic hormone Amylase
Amylin
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 2 PM and 4 PM Between 10 AM and 12 noon Between 12 noon and 8 PM Between 8:30 AM and 9:30 AM
idkk
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? isophane insulin suspension insulin aspart insulin lispro insulin glargine
insulin glargine
Which would the nurse identify as an effect of somatostatin on blood glucose Increased insulin release Decreased glucagon release Increased GI emptying Decreased insulin sensitivity
decreased glucagon release
A client has been noncompliant with the diabetic medication regimen and develops diabetic ketoacidosis. Which would the nurse assess? Edema Decreased blood glucose levels Deep respirations Sour breath odor
deep respirations
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? "My mother is going to give me my insulin." "I walk two blocks to school every day." "I am on the middle school track team." "We live in a two-story house."
"I am on the middle school track team."
When considering the management of diabetic ketoacidosis (DKA), what type of insulin can be administered intravenously? isophane insulin (NPH) lispro regular insulin glargine
regular
What statement would be appropriately included in the teaching concerning type 2 diabetes? "Until you need to start insulin injections, you do not have to check your blood sugar." "If you drink alcohol, it may be necessary for you to increase your oral antidiabetic medication." "Clients with type 2 diabetes always progress to insulin injections if they do not follow dietary guidelines." "Regular exercise makes your body better able to use the insulin it produces."
"Regular exercise makes your body better able to use the insulin it produces."
Heavy intake of which herb should be avoided by a client who is prescribed an antidiabetic medication? -oregano -basil -garlic -anise
Garlic
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 is used to move carbohydrate particles from the gastrointestinal system to the liver." "Insulin is stimulated by the liver to break down proteins and provide the body with nutrients." "Insulin causes fat to be broken down to provide energy for the body." "Insulin assists glucose molecules to enter the cells of muscle and fat tissues."
"Insulin assists glucose molecules to enter the cells of muscle and fat tissues."
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? "I should not administer the insulin if it is cloudy." "The insulin is given only once per day, at night." "I must give this insulin alone and not mix with other insulins." "The medication will peak in 3 hours."
"The medication will peak in 3 hours."
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? Administer the insulin to the client. Check the dosage with another nurse. Check the client's blood sugar again. Ensure a meal tray is available.
Check the dosage with another nurse.
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? Regular Detemir Lispro Lente
Detemir
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? Contact the prescriber to obtain an order for 2 more units of NPH Contact the prescriber to obtain an order for 4 more units of regular insulin Document the finding and check the client's blood glucose level in one hour Monitor the client closely for signs and symptoms of hyperglycemia
Document the finding and check the client's blood glucose level in one hour
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 1-3 days Every one month Every two weeks Every 5-7 days
Every 1-3 days
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.) Pramlintide Repaglinide Glimepiride Glyburide Tolazamide
Glimepiride Glyburide
The nurse monitoring a client receiving insulin glulisine 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.) Insulin glargine (Lantus) Insulin detemir (Levemir) Glucose tablets Hard candy Orange or other fruit juice
Glucose tablets Hard candy Orange or other fruit juice
Which would a nurse identify as an example of a sulfonylurea? Metformin Miglitol Glyburide Acarbose
Glyburide
Which is the best indicator of overall diabetic control? Fasting blood glucose levels 2-hour postprandial blood glucose levels Glycosylated hemoglobin levels Absence of acetone in the urine
Glycosylated hemoglobin 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 Bradycardia Lipodystrophy Hypotension
Hypoglycemia
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
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 Glipizide Tolbutamide Miglitol
Metformin
Amylin is a peptide hormone secreted with insulin by the beta cells of the pancreas and is important in the regulation of glucose control during the postprandial period. True or false? T/F?
True
Regular insulin may be administered intravenously or intramuscularly in an emergency situation. T/F?
True
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. Stay calm and still until the reaction subsides. Inject a prescribed dose of insulin as soon as you suspect the reaction is occurring. Notify your health care provider immediately.
Take an oral dose of some form of glucose as soon as possible.
A nurse is preparing to administer a rapid-acting insulin. Which medication would the nurse most likely administer?
insulin lispro
The nurse should include what information when educating a client prescribed insulin regarding the characteristics of hypoglycemia? Select all that apply. characterized by feeling sluggish the onset of symptoms/signs is sudden affected by increased emotion triggered by missing a regular meal associated with a lack of insulin
the onset of symptoms/signs is sudden affected by increased emotion triggered by missing a regular meal
During a teaching session on the care of the client with diabetes, the nurse should make which statement to explain the differences in insulin? Insulin type is matched with the appropriate oral hypoglycemic agent." "Insulins have different onsets and durations of action." "Insulin is prescribed based on the client's age." "Insulin is prescribed based on the insurer's criteria for reimbursement."
"Insulins have different onsets and durations of action."
A patient is to be administered glipizide (Glucotrol). Which factor would prohibit the administration of glipizide (Glucotrol) to this patient? The ingestion of carbohydrates Increase in alkaline phosphatase Allergy to sulfonamides A diagnosis of hypertension
Allergy to sulfonamides
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? arrange to have the client's random blood glucose measured. Assess the most recent hemoglobin A1C levels. Dialogue with the client about implemented management strategies. Review and discuss the data contained in the client's written blood glucose log.
Assess the most recent hemoglobin A1C levels.
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? Insulin lispro Diazoxide Regular insulin Glucagon
Glucagon
The nurse is preparing to administer insulin lispro (Humalog) to a client at 7 AM. What is the nurse's top priority intervention related to this medication? Make sure the client's breakfast is available in the next 5-10 minutes. Monitor the client for a hypoglycemic reaction at noon. Cleanse the administration site with soap and water before administration. Have the client lie quietly for 45 minutes.
Make sure the client's breakfast is available in the next 5-10 minutes.
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: NPH. Regular. Lente. Ultralente.
Regular
Patients with type 2 diabetes have nonfunctioning beta pancreatic cells. T/F? How about type 1??
Type 2: False, has functioning beta cells, there is just an insulin resistance. Type 1: True
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? platelet count liver enzymes D-dimer creatinine
liver enzymes
The nurse is caring for a client taking insulin. The nurse realizes the client is experiencing symptoms of hypoglycemia when the client displays: decreased respiratory rate and hot, dry skin. increased pulse rate and fruity smelling breath. weakness, sweating, and decreased mentation. increased thirst and increased urine output.
weakness, sweating, and decreased mentation.
A client is receiving metformin therapy at a health care facility. The client is also prescribed glucocorticoids. The nurse would be alert for which adverse reaction due to the interaction of these two drugs? increased hypoglycemic effect increased risk of lactic acidosis increased risk for bleeding delay in gastric emptying
increased risk of lactic acidosis
An older adult client has been prescribed metformin for the treatment of type 2 diabetes for several years. Which change in the client's laboratory values may demonstrate a need to discontinue the medication? An increase in serum lactate A decrease in hemoglobin and hematocrit A decrease in potassium accompanied by an increase in sodium An increase in white blood cells
An increase in serum lactate
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. Pramlintide should only be injected in the hip. Inject pramlintide in the same site where insulin is administered. Mix pramlintide in the same syringe with insulin.
Do not give pramlintide in the same site where insulin is administered.
The nurse is instructing a client how to take a prescribed pramlintide. Which would be most appropriate? "Take the drug orally with the first bite of each meal." "Take the drug orally once a day, preferably in the morning." "Give it by subcutaneous injection immediately before your major meals." "Give yourself an injection 1 hour before you eat breakfast and dinner."F
Give it by subcutaneous injection immediately before your major meals."
The nurse is interviewing a client who was diagnosed with type 2 diabetes about four months ago. The client never records glucometer readings but says that everything is just fine. What laboratory test does the nurse anticipate the health care provider will order for this client? Stat urine for glucose Fasting blood glucose in the AM HbA1c Insulin level
HbA1c
When describing the effects of incretins on blood glucose control to a group of students, which would an instructor include? Increases glucagon release Increases insulin release Increases GI emptying Increases protein building
Increases insulin release
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. The insulin is more effective in establishing control of blood glucose levels initially. The client most likely does not exercise enough to control his glucose levels. More insulin is needed than that which the client can produce naturally.
Insulin is needed because the beta cells of the pancreas are no longer functioning.
Which would be appropriate to include in teaching a client with type 2 diabetes? It is possible with weight loss and exercise to discontinue the use of antidiabetic medication. Clients with type 2 diabetes always progress to insulin injections if they do not follow dietary guidelines. Until you need to start insulin injections, you do not have to check your blood sugar. If you drink alcohol, it may be necessary to increase your oral antidiabetic medication.
It is possible with weight loss and exercise to discontinue the use of antidiabetic medication.
The nurse admits a client who has been diagnosed with diabetic ketoacidosis, and will look for what assessment findings consistent with this diagnosis? (Select all that apply.) Blood glucose 191 mg/dL Flushed, dry skin Ketones in the urine Lack of thirst Rectal pressure
Ketones in the urine Flushed, dry skin
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? Document family medical history. Assess the skin for ulcers, cuts, and sores. Monitor the patient for lipodystrophy. Observe the patient for hypoglycemic episodes.
Observe the patient for hypoglycemic episodes.
The nurse is preparing to administer 20 units of NPH insulin to a client. Before administering the medication, the nurse should implement which intervention? Assess the client's understanding of diabetes. Massage the chosen injection site. Assess the client's urine for the presence of glucose. Have a colleague confirm the dosage.
Have a colleague confirm the dosage.
A client was diagnosed with type 2 diabetes several months ago and 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 his/her blood glucose levels. The client tells the nurse that he/she has gone on a diet. The client exercises two to three times per week. The client can describe the differences between type 1 and type 2 diabetes.
The client frequently checks his/her blood glucose levels
Which condition must be met in order for glyburide treatment to be effective? The client must be able to self-administer the medication. The client must not have hyperglycemia. The client must have functioning pancreatic beta cells. The client must have hemoglobin A1C of ≤7%.
The client must have functioning pancreatic beta cells.
A 58-year-old male client, diagnosed with diabetes at age 14, reports having pain in both feet and hands. What is this pain most likely a result of?
peripheral neuropathy
The nurse has just completed discharge instructions to a client who will be using a pen device to deliver his insulin dose. What statement by the client indicates a need for further instruction? "I need to turn the dial on the pen and listen for the locking ring before administering my insulin." "I determine my dosage by the number of clicks that I hear." "This will make it easier for me to give my own insulin because of my poor eyesight." "If I forget to take my insulin pen, I will be able to use the one that my wife uses."
"If I forget to take my insulin pen, I will be able to use the one that my wife uses."
Insulin is produced by which organ in the human body? Liver Spleen Kidney Pancreas
Pancreas
When administering insulin, what would be most appropriate? Firmly spread the skin of the area of the intended site of injection. Massage the injection site firmly after removing the needle and syringe. Shake the vial vigorously to ensure thorough mixing before drawing up the dose. Insert the needle at a 45-degree angle for injection.
Insert the needle at a 45-degree angle for injection.
Glycosylated hemoglobin measures average blood glucose over what time period? The past 12 to 24 hours The past 1 or 2 months The past 7 to 10 days The past 3 or 4 months
The past 3 or 4 months... From the book.. "a blood glucose marker that provides a 3-month average of blood glucose levels." AKA.. HgA1C
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? Administer glucagon by the parenteral route. Administer oral antidiabetics to the patient. Administer the insulin via insulin pump. Give oral fluids or candy.
Give oral fluids or candy.
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? The metformin will be temporarily substituted for with insulin, to address the risk of potential kidney failure. The client will be prescribed an extra dose of metformin due to address the contrast material's effect on the body. Metformin should be discontinued at least 48 hours before and after diagnostic tests that use contrast medias. The client needs to be encouraged to drink 1 to 2 L of water to flush the contrast media out the kidneys.
Metformin should be discontinued at least 48 hours before and after diagnostic tests that use contrast medias.
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. carbohydrate use and insulin levels. protein intake and hyperglycemia. hypoglycemia and glucagon levels.
hyperglycemia and glycosuria.
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 07:00 06:45 06:00 06:2
06:45
A client has been prescribed glucagon for the management of hypoglycemia. Which nursing interventions should the nurse be prepared to provide this client for the management of possible adverse effects? Select all that apply. Administration of a prescribed suppository for the management of nausea Provide prescribed analgesic for headache Ready access to supplemental oxygen Implementation of aspiration precautions Monitor for cardiac arrhythmias
Administration of a prescribed suppository for the management of nausea Ready access to supplemental oxygen Implementation of aspiration precautions
A nurse is assigned to administer glargine to a patient at a health care facility. What precaution should the nurse take when administering glargine? Shake the vial vigorously before withdrawing insulin. Administer insulin that has been refrigerated. Administer glargine via IV route. Avoid mixing glargine with other insulin.
Avoid mixing glargine with other insulin.
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? Dry skin Fruity breath Flushing of the face Blurred vision
Blurred vision Explanation: 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.
A female client visits the physician's office after routine labs are drawn. The nurse notes that her A1C is 9. How does the nurse interpret this finding? Client is in good glycemic control. Client's blood glucose levels are not consistent. Client's blood glucose demonstrates longstanding hypoglycemia. Client's average blood glucose is above normal.
Client's average blood glucose is above normal.
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
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 Increased thirst Diaphoresis Increased urination Confusion
Headache Confusion Diaphoresis
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? Do not administer insulin kept at room temperature. Keep prefilled syringes horizontally. Check for symptoms of myalgia or malaise. Inspect the previous injection site for inflammation.
Inspect the previous injection site for inflammation.
Which is an example of long acting insulin? Isophane insulin suspension (Humulin N) Insulin lispro (Humalog) Insulin aspart (Apidra) Insulin glargine (Lantus)
Insulin glargine (Lantus)
What is an example of rapid acting insulin? Insulin Glargine (Lantus) Isophane insulin suspension (Humulin N) Insulin detemir (Levemir) Insulin lispro (Humalog)
Insulin lispro (Humalog)
What is the expected action of sitagliptin on type 2 diabetes? It inhibits hydrogen, potassium, and ATPase. It slows the rate of inactivation of the incretin hormones. It is a synthetically prepared monosodium salt. It blocks the S phase of the cell cycle.
It slows the rate of inactivation of the incretin hormones.
Which would be least appropriate when administering insulin by subcutaneous injection? Inserting the needle at a 45-degree angle Massaging the site after removing the needle Using a 25 gauge 1/2-inch needle Injecting the insulin slowly
Massaging the site after removing the needle
A client is prescribed sitagliptin. The nurse would expect to administer this drug by which route? Oral Subcutaneous Intramuscular Intravenous
Oral
What statement would be appropriately included in the teaching concerning type 2 diabetes? Until you need to start insulin injections, you do not have to check your blood sugar." "Regular exercise makes your body better able to use the insulin it produces." "Clients with type 2 diabetes always progress to insulin injections if they do not follow dietary guidelines." "If you drink alcohol, it may be necessary for you to increase your oral antidiabetic medication."
Regular exercise makes your body better able to use the insulin it produces.
A patient is in diabetic ketoacidosis. The patient blood glucose level is over 600. The physician has ordered the patient to receive an initial dose of 25 units of insulin. What type of insulin will be administered intravenously? Regular insulin NPH insulin Lente insulin Ultralente insulin
Regular insulin
The nurse is preparing to administer insulin intravenously to a client with a blood glucose level over 600 mg/dL (33.33 mmol/L). What type of insulin will the nurse most likely give?
Regular insulin
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.) Reinforce instructions on dealing with hypoglycemia. Watch the client draw up and administer her insulin. Encourage the client to check her blood glucose every hour. Instruct the client to go to the emergency department immediately if she develops a cold or upper respiratory infection. Assist the client in making menus that will meet the needs of both the client and the family.
Reinforce instructions on dealing with hypoglycemia. Watch the client draw up and administer her insulin. Assist the client in making menus that will meet the needs of both the client and the family.
Which produce their glucose lowering effect by decreasing insulin resistance and increasing insulin sensitivity? (Select all that apply.) Pioglitazone (Actos) Metformin (Glucophage) Rosiglitazone (Avandia) Miglitol (Glyset) Acarbose (Precose)
Rosiglitazone (Avandia) Pioglitazone (Actos)
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? Epigastric discomfort Tachycardia Flatulence Myalgia
Tachycardia
The nurse is providing education to a client who has been prescribed therapy with an antidiabetic medication. During teaching, the nurse will caution the client against heavy intake of which herb? Garlic Basil Anise Oregano
garlic
A client's current condition requires rapid reduction of blood sugar levels. Which type of insulin will have the most rapid onset of action? isophane (NPH) isophane (NPH) Humulin R insulin lispro
insulin lispro
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 12 to 24 hours the past 1 or 2 months the past 7 to 10 days the past 3 or 4 months
the past 3 or 4 months
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 Infection Impaired glucose tolerance Poor insulin injection technique
widespread changes in the blood vessels
