Diabetic Drugs
Which oral non-insulin drug is contraindicated in patients with renal impairment?
metformin
A patient diagnosed with type 2 diabetic states, "I do not eat breakfast, but I will make sure to take my repaglinide." What is a correct response by the nurse?
"Skipping meals can cause your blood glucose to drop."
A nurse administering NPH insulin would expect peak effect to occur in what time frame?
6-12 hours
Which patient with diabetes should the nurse assess first?
A patient who reports palpitations and tachycardia
A patient taking insulin has developed hypertension and has been prescribed a thiazide diuretic. Which statement made by the patient indicates a need for additional teaching about the interactions between the two medications?
My insulin dose will need to be decreased." Thiazide diuretics increase blood sugar, so the insulin dose would need to be increased, not decreased
The nurse is providing patient education on how acarbose helps treat diabetes. Which statement is most appropriate?
Prevents starches from immediately breaking down to simple sugars
The nurse is preparing a combination of insulins for a subcutaneous injection. Which insulin should the nurse draw up first?
The short-acting insulin The short-acting insulin should be drawn into the syringe first to avoid contamination of the short-acting insulin by the NPH insulin. Only NPH insulin is appropriate for mixing with short-acting insulins.
The nurse should instruct Cates to immediately report which symptoms?
thirst increased urine output sweet, fruity breath
A newly-diagnosed type 2 diabetic patient asks the nurse, "Why do I need to rotate my injection sites?" Which nursing response is correct?
"Rotating injection sites in the abdomen promotes insulin absorption"
What nursing intervention is best practice prior to the administration of insulin?
Verification of the dosage by two nurses
A patient with type 2 diabetes who has been admitted to the hospital for infection has been taking regular insulin for 10 years. Which statement made by the patient indicates a need for additional teaching?
"My insulin needs will be decreased." Blood glucose levels can be elevated during stressful times, such as during an infection. Insulin doses may need to be increased for a period of time.
A nurse is providing patient education on repaglinide. Which statement is correct?
"Take this medication 30 minutes or less before eating."
A nurse is administering insulin glargine to a patient. What is the onset of action of this medication?
1-5 hours
At what time of day would a nurse expect to administer a dose of exenatide subcutaneously?
60 minutes or less before the patient's meal Exenatide is given to increase glucose control with type 2 diabetes. It should be administered twice a day, 60 minutes or less before the morning and evening meals
What instructions should the nurse provide to a patient about an insulin pump prior to discharge?
Change the infusion set every 1-3 days. Move the catheter at least 1 inch away from the previous site.
A nurse is treating an unconscious adult who is covered in sweat. The person has a history of diabetes. A blood glucose of 20 mg/dL is obtained. What should the nurse administer first?
Glucagon
A patient with type 2 diabetes has a blood glucose of 50 mg/dL and the patient's scheduled dose of insulin is due. What is the appropriate nursing intervention?
Hold scheduled dose and give orange juice
The nurse asks a patient to state the symptoms of hypoglycemia to assess understanding. Which symptom stated by the patient indicates a need for additional teaching?
Increased energy
What physiological response would the nurse expect in a patient after administration of insulin?
Increased glucose uptake Insulin stimulates cellular uptake of glucose, amino acids, nucleotides, and potassium. Insulin also promotes synthesis of complex organic molecules.
Four patients have been prescribed a non-insulin drug. Following administration of the drug, each patient has developed new symptoms. Which assessment data would indicate that the patient has a priority need for nursing intervention?
Itching and rash Itching and rash may indicate a hypersensitivity reaction to the medication and a potential anaphylaxis reaction. The patient with these symptoms would be given the highest priority.
Which type of insulin has an onset time of 15 minutes?
Lispro
What oral anti-diabetic drug should be withheld for 48 hours before and after tests that require intravenous contrast dye?
Metformin Intravenous contrast dye that contains iodine has the potential to cause acute chronic kidney disease. Because metformin is contraindicated in patients with renal dysfunction, it should be discontinued a day or two prior to the procedure and resumed 48 hours after the procedure, once lab results show normal renal function
Upon assessment, the nurse finds that a patient who has type 2 diabetes is alert, awake, pale, and complaining of weakness and nervousness. Which action should the nurse take first?
Obtain a blood glucose level
A home health nurse is visiting a patient with type 2 diabetes to prefill insulin syringes. Where should the nurse store the prefilled insulin syringes?
Refrigerator Prefilled syringes can be stored in a refrigerator for up to 2 weeks.
Which insulin can be administered intravenously?
Regular insulin
Which non-insulin drug(s) should not be administered to a patient who is breastfeeding?
Sulfonylureas
What class of medications is contraindicated for a patient with type 1 diabetes?
Sulfonylureas In type 1 diabetes, the pancreas is incapable of insulin synthesis. Sulfonylureas act primarily on the release of insulin from the pancreas and will therefore be ineffective.
A patient presents to the emergency department reporting heart palpitations. The patient is flushed, smells of alcohol, and is taking glipizide. What might the nurse suspect based on this clinical presentation?
The alcohol is reacting with the glipizide. When alcohol is combined with a sulfonylurea medication such as glipizide, a disulfiram-like reaction may occur or potentiate the hypoglycemic effects of the sulfonylurea. Symptoms of the disulfiram-like reaction include flushing, palpitations, and nausea.
A type 2 diabetic patient who has been taking pioglitazone for 5 years has recently been diagnosed with heart failure. Which intervention can the nurse expect the health care provider to implement?
The current medication will be changed. Pioglitazone increases plasma volume, causing fluid retention, and is contraindicated for patients with heart failure.
What onset of action would a nurse expect when administering glyburide?
within 1 hr
