EDAPT: Glucose Regulation

After administering intermediate-acting insulin to a client at 0800, the nurse should understand that the duration of action will end at what time?

Between 1800 and 0200

Which class of medications is the first drug used to treat diabetes mellitus (DM) type 2?​

Biguanides

The nurse is caring for a young adult admitted to the intensive care unit (ICU) with pneumonia and hyperglycemia. When the nurse reassesses the client 1 hour after administering the insulin lispro, which finding best indicates the medication was effective?

Capillary glucose 122 mg/dL

The nurse is caring for a young adult admitted to the intensive care unit (ICU) with pneumonia and hyperglycemia. ​ Select the four (4) assessment findings the nurse should follow up on immediately.​

Client pointing to cup and then mouth Client rubbing head Capillary glucose Shivering

The nurse should expect the appearance of insulin isophane suspension (aka NPH) to have which characteristic?

Cloudy

Long-acting insulins, such as insulin glargine, provide what advantages for clients living with diabetes compared to regular insulin? Select all that apply.​

Decreased emergency department (ED) visits Fewer long-term complications Fewer daily injections

Which health alteration is characterized by the lack of insulin production?

Diabetes mellitus type 1

The nurse is caring for a client who is alert, oriented, and cooperative, despite having diabetic ketoacidosis (DKA). As the nurse is starting the prescribed insulin via continuous intravenous infusion, which symptoms should the nurse instruct the client to report immediately? Select all that apply.​

Diaphoresis Fast heart rate

The nurse evaluates a client's understanding of hypoglycemia caused by insulin administration. Which clinical manifestations listed by the client indicate they will be able to recognize an insulin-related hypoglycemic episode? Select all that apply.​

Diaphoresis Tachycardia

The nurse is observing a client administering a dose of insulin and determines the client understands the correct technique when which behaviors are observed? Select all that apply. ​

Drops the needle into the appropriate container. Selects the anterior thigh. Rotates the injection site.

The first five nights after Amelia (pronouns she, her, hers) started administering the combined neutral protamine hagedorn (NPH) and regular insulin, she woke during the night with symptoms of low blood sugar. What is the most likely instruction her parent received from the pediatric endocrinologist?

Eat a snack before bedtime.

The nurse administered lispro insulin to a client at 0730 after verifying the client intended to eat their breakfast, which was present in the room. The client asks how long the effects of the lispro will last. What is the best response by the nurse?

"Lispro's effects last between 3-5 hours."

The parents of a school-aged child newly diagnosed with diabetes mellitus type 1 ask the nurse how to prevent their other children from having this same disease. What is the best response by the nurse?

"Take time to keep your children fully vaccinated as recommended by their healthcare provider."

A client that is hospitalized with newly diagnosed diabetes mellitus type 1 asks the nurse why they will need to take shots of insulin when their grandparent, who has diabetes mellitus type 2, takes a pill. What information should the nurse include when responding? Select all that apply.​

"Insulin does not come in a pill form." "Your body does not produce insulin."

A client being treated with oral antidiabetic medications asks the nurse to explain how one shot of insulin glargine each day can improve their diabetes mellitus (DM) type 2. Which response by the nurse is best?​

"Insulin glargine helps your muscle and fat cells use glucose."

The nurse administers 14 units of insulin isophane suspension (NPH) to a client at 0700 in the lower right quadrant of the abdomen. Before leaving the room, the nurse should inform the client that someone should be back to recheck their glucose around what time?​

1130

Which statement made by a client receiving teaching about managing their diabetes mellitus (DM) type 1 with insulin indicates that more teaching is required?

"As long as I administer insulin and maintain a normal glucose, I can eat whatever I want."

A client whose diabetes mellitus is well-controlled with a single injection of insulin glargine has been admitted to the intensive care unit (ICU) with diabetic ketoacidosis (DKA). In addition to receiving the normal dose of glargine subcutaneously, the client is also on a continuous intravenous (IV) infusion of regular insulin. The client asks the nurse why the glargine cannot be given through the IV as well. What is the best response by the nurse?​

"Glargine forms small crystals in the body which could harm you if given IV."

After subcutaneous injection, how quickly does lispro's therapeutic effect begin?​

15 minutes

A client becomes upset while learning how to administer their newly prescribed insulin. What is the best response by the nurse when the client says, "I cannot do this for the rest of my life," and walks to the other side of the room?​

"This is a big change. Would you like to talk about how this is affecting you?"

While completing a medication reconciliation for a client admitted to the hospital, the nurse notes that the client's regular insulin and insulin isophane suspension (NPH) both have a cloudy appearance. What information should the nurse give to the client?

"When you get home, get a new bottle of regular insulin."

The nurse is caring for a young adult admitted to the intensive care unit (ICU) with pneumonia and hyperglycemia. ​ For each clinical manifestation below, specify if it could be caused by diabetes mellitus (DM) type 1, intubation, or pneumonia.​

*DM Type 1:* Capillary glucose Dry mouth​ Shivering​ Headache​ *Intubation​:* Dry mouth​ *Pneumonia​:* Capillary glucose Shivering​ Headache​

For each effect listed, specify if regular insulin does or does not affect the body.

*Does Affect:* • Inhibits hepatic glucose production • Enhances protein synthesis • Inhibits lipolysis *Does Not Affect:* • Increases serum glucose • Controls hypoglycemia in diabetic clients​

The nurse is caring for a young adult admitted to the intensive care unit (ICU) with pneumonia and hyperglycemia. For each nursing action, specify if it is indicated, nonessential, or contraindicated.

*Indicated:* • Administer lispro insulin subcutaneously per sliding scale​. *Nonessential:* • Increase temperature in room​. • Notify the healthcare provider of serum glucose​. *Contraindicated:* • Administer acetaminophen 650 mg orally for fever​. • Increase IV fluids to dilute serum glucose​. • Wait at least 4 hours to recheck serum glucose​.

For each clinical manifestation listed, specify if it is likely to be present or not likely to be present in a client who received 15 units of rapid-acting insulin and was taken for an x-ray before finishing their meal.​

*Likely to Occur:* Palpitations Weakness Lethargy *Not Likely to Occur:* Drowsiness Polyuria Polydipsia

For each client listed, indicate if the client must use insulin, may need insulin, or does not need insulin.​

*Must Use Insulin​:* • A teenaged client whose pancreas does not produce insulin. *May Need Insulin​:* • A woman in the third trimester of pregnancy with an elevated blood glucose level. • An adult with diabetes mellitus type 2 taking an oral antidiabetic medication who is ill. *Does Not Need Insulin​:* • A client who is obese and has a blood sugar higher than normal, but less than 126 mg/mL.

The nurse is teaching an adult who was recently prescribed a long-acting insulin in addition to their oral antidiabetic medications. For each statement made by the client, specify if the client needs additional teaching or understands the teaching.​

*Needs Additional Teaching​:* • "Signs of hypoglycemia include hunger, thirst, and frequent urination."​ • "The goal of adding insulin to my plan of care is a glycosylated hemoglobin (Hb A1C) less than 4%."​ *Understands the Teaching​:* • "I will notify my healthcare provider if my blood sugar increases when I am not feeling well."​ • "If my blood sugar falls below 65 mg/dL and I feel shaky, I will drink a small glass of orange juice."​ • "I will keep a simple carbohydrate, like oral glucose tablets or hard candy, with me in case I start to feel like my blood sugar is low."​

For each action listed, specify if the nurse should or should not complete the action prior to administering a prescribed subcutaneous (subq) dose of short-acting insulin.​

*Nurse Should Complete:* • Assess the blood glucose level. • Confirm the type of insulin with another licensed nurse. *Nurse Should Not Complete:* • Administer 1 hour prior to a meal. • Remind the client to remain in bed for 30 minutes. • Use the same injection site for one week.

The nurse preparing a client's 0730 dose of lispro insulin should confirm that a meal tray will be available and the client ready to eat at what time?

0730

The nurse administers lispro to the client at 0800. The nurse should remind the client to eat right away since the onset of action for this dose of lispro will begin at what time?

0815

​After administering a single injection of insulin isophane suspension (NPH) to a client at 0730, at what time should the nurse return to the client's room to make sure they have eaten?

0930

What is the onset for insulin glargine?

1-2 hours

What is the onset of intermediate-acting insulin?

1-2 hours

Use the drop-down menus on the graph to indicate the type of insulin pharmacokinetics represented.

1. Rapid-acting 2. Short-acting 3. Intermediate-acting 4. Long-acting

Place the steps the nurse should take when combining different types of insulin in one syringe in the correct order.

1. Wash hands 2. Gently rotate insulin isophane suspension (NPH) vial 3. Wipe tops of both vials with alcohol. 4. Inject air equal to NPH dose into NPH vial. 5. Inject air equal to regular dose into regular vial. 6. Invert regular insulin bottle and withdraw regular insulin dose. 7. Without adding more air to the inverted NPH vial, carefully insert the syringe and withdraw the NPH dose.

The nurse is caring for a young adult admitted to the intensive care unit (ICU) with pneumonia and hyperglycemia. Since it is 2045 and the client is due to receive the evening dose of NPH, the nurse decides to mix the sliding scale dose of lispro with the NPH. Place the steps the nurse should follow to safely mix the insulins in one syringe in the correct order.

1. Wash hands​ 2. Gently rotate the intermediate-acting insulin vial​. 3. Wipe off the tops of both insulin vials with alcohol. 4. Inject air equal to the intermediate-acting insulin dose into the intermediate-acting insulin vial​. 5. Inject air equal to the short-acting insulin dose into the short-acting insulin vial​. 6. Invert the short-acting insulin vial and withdraw the short-acting insulin dose​. 7. Without adding more air to the intermediate-acting insulin, carefully insert the syringe and withdraw the intermediate-acting insulin.

When administering regular insulin intravenously (IV), the nurse expects the onset of action to begin within what time frame?

10 minutes

After administering a dose of lispro at 0915, the nurse should plan to return to the client's room to reassess their response to the peak effect of the insulin at what time?​

1015

It is 0700 and the nurse is caring for four clients on insulin therapy. Based on the type of insulin used and the time their last dose was administered, indicate the optimal time for each client to eat breakfast.

63 units glargine subcutaneously at 2120 the day before​ - Upon request of client​ 70 units of lispro subcutaneously at 0655 today​ - Within 5 minutes​ 70% NPH/30% regular subcutaneously at 0645 today​ - Between 0715 and 0745​

Which client is at greatest risk of experiencing frequent hypoglycemia?

A client with diabetes mellitus type 1

The nurse should understand that a client who is taking which insulin twice daily is at higher risk for insulin-related hypoglycemia?

A mix of regular and NPH insulin.

The nurse determines that the client understands treating hypoglycemia when they identify which items as containing 15 grams of simple carbohydrates? Select all that apply.

A serving of glucose gel Five to six pieces of hard candy One tablespoon of sugar

After administering intermediate-acting insulin to a client at 0800, the nurse should understand that the peak effect will occur at what time?

Between 1200 and 1600

The nurse receives a call from the unlicensed assistive personnel (UAP) who notifies them a diabetic client is weak, tired, shaking, and has a rapid pulse. As the nurse enters the client's room, they see the UAP gently shaking the client and calling their name, but the client does not reply.​ Based on this information, the nurse should __________ immediately. The nurse should prepare to __________.​

Administer glucose Recheck the client's glucose

Which clients should benefit from the addition of glargine to their diabetes mellitus (DM) treatment plan? Select all that apply.

An adolescent living with DM type 1 whose serum glucose fluctuates widely. An adult with DM type 2 who is not achieving glycemic control on oral medications. An adult whose serum glucose is well controlled on two daily injections of insulin isophane suspension (NPH).

After administering 40 units of regular insulin subcutaneously to a client at 0800, the nurse should understand that the onset of action will occur at what time?​

Around 0845

After administering insulin glargine to a client at 2100, the nurse should anticipate that the client's serum glucose may increase around what time?​

Around 2030 the next day.

After administering 40 units of regular insulin subcutaneously to a client at 0800, the nurse should understand that the duration of action will occur at what time?​

Between 1400 and 1800

After administering insulin glargine to a client at 2100, the nurse should anticipate that the client's serum glucose level may drop due to the medication peaking at what time?

At no time

Glargine is sometimes referred to as a __________ insulin because its ability to maintain __________ control between meals is like that of the __________.​

Basal Glycemic Pancreas

After administering intermediate-acting insulin to a client at 0800, the nurse should understand that the onset of action will occur at what time?

Between 0900 and 1000

After administering 40 units of regular insulin subcutaneously to a client at 0800, the nurse should understand that the peak effect will occur at what time?​

Between 1000 and 1200

Lispro insulin lowers blood glucose by regulating the metabolism of which nutrients? Select all that apply.

Fats Proteins Carbohydrates

Insulin glargine can be administered subcutaneously to which sites on the body? Select all that apply.​

Front of thigh Upper hip Lower abdomen

Lispro is used to help control which laboratory value in clients living with diabetes mellitus type 1 or 2?​

Glucose

When taking insulin, the intent is to lower which laboratory value to achieve findings within the normal range?

Glucose

Which assessment data is most reliable for determining the effectiveness of treatment in clients living with diabetes mellitus (DM) type 2?

Hemoglobin A1C (A1C)

Clients taking medication to treat diabetes mellitus (DM) type 2 share which primary treatment goal?​

Hemoglobin A1C is less than 6.5%​

When administered to clients with either diabetes mellitus type 1 or 2, lispro controls which condition?​

Hyperglycemia

With type 1 or type 2 diabetes mellitus, NPH​ insulin controls which of the following?

Hyperglycemia

Twenty minutes after the nurse administered 15 units of regular insulin subcutaneously to a client at 0815, the healthcare provider scheduled a procedure at 1230 for which the client must be NPO (having no oral intake) starting immediately. ​ The nurse should recognize that the client is at high risk for __________ in the next __________ minutes and again close to the __________ of the procedure.​

Hypoglycemia 45 Start

The nurse is caring for a client living with diabetes mellitus type 1 who receives 85 units of insulin glargine at 2100 daily. The client was admitted with prolonged vomiting due to gastroenteritis and has been unable to take in food or fluids for the last day. This client is at high risk of developing prolonged __________ due to __________ and __________.​

Hypoglycemia Not eating Taking glargine

Insulin isophane suspension (aka NPH) is which type of insulin?

Intermediate-acting insulin

When caring for an unstable client in the intensive care unit (ICU) with a dangerously high serum blood glucose, the nurse should prepare to administer regular insulin via which route?

Intravenous (IV)

__________ administration of insulin is usually administered to clients with extremely __________ serum glucose levels who are __________ and on a/an __________ unit.

Intravenous (IV) High Unstable Intensive care

A client taking which type of insulin to treat their diabetes mellitus (DM) is least likely to experience hypoglycemia if they skip a meal?​

Long-acting

A client who received lispro at 0810 is discovered by the nurse at 0915 in bed. The client is pale, diaphoretic, and mumbles when asked how they are feeling. Which nursing intervention is the highest priority for this client?

Measure capillary blood glucose level at the bedside.

Intermediate-acting insulin, such as __________, is used to control serum __________ levels in clients living with diabetes __________.

NPH Glucose Mellitus

What is true about mixing insulin glargine?

Not compatible with other insulins.

While preparing to administer a prescribed dose of lispro to a client, the nurse discovers that the unit is out of lispro insulin. Which action should the nurse take next? ​

Notify the pharmacy of the missing medication.

Identify the onset of action, peak level, and duration of action of glargine.

Onset: 1-2 hours Peak: None Duration: 24 hours

Indicate the onset of action, peak effect, and duration of action for glargine using the drop-down menus to complete the table.

Onset: 1-2 hours Peak: None Duration: 24 hours

Identify the onset of action, peak level, and duration of action of lispro.

Onset: 15 minutes Peak: 1-2 hours Duration: 3-5 hours

Identify the onset of action, peak level, and duration of action of regular insulin.

Onset: 30-60 minutes Peak: 2-4 hours Duration: 6-10 hours

Thirty (30) minutes after administering lispro to a client with diabetes mellitus type 1, the nurse returns to the room and sees the client has not eaten their lunch. When asked how they feel, which client responses indicate to the nurse that the client is experiencing hypoglycemia related to the lispro injection? Select all that apply.

Palpitations Tremors Weakness Tachycardia

What symptoms provided by the client indicate to the nurse that a client with a new prescription for intermediate-acting insulin understands insulin-related hypoglycemic reactions? Select all that apply.

Palpitations Weakness Shakes Diaphoresis

Where is insulin produced in the human body?

Pancreas

Which pharmacokinetic variables should the nurse teach the client about insulin? Select all that apply.​

Peak Duration Onset

The nurse educates the client on the importance of having adequate glucose available during which time/action components of insulin administration? Select all that apply.

Peak Onset

What foundational knowledge about insulin should the nurse possess to ensure the safe administration of insulin to clients? Select all that apply.

Peak effect Duration of action Prescribed route Prescribed dose Onset of action

While teaching a client recently diagnosed with diabetes mellitus type 1, the nurse asks the client to list the symptoms of hypoglycemia. Which client responses should indicate to the nurse that further teaching is needed? Select all that apply.

Polydipsia Polyuria Fruity breath odor

The nurse is identifying a client before administering a dose of regular insulin and notices the client is scratching their abdomen to the right side of their naval. When asked if the area is painful or irritating, the client replied, "It itches a bit, and I noticed it yesterday about 30 minutes after my evening insulin shot." Which assessment cues, if present, should the nurse recognize as being related to a localized reaction to the shot? Select all that apply.​

Pruritis Inflammation Erythema

Lispro is which type of insulin?

Rapid-acting insulin

What other types of insulin can intermediate-acting insulin be mixed with in a syringe for administration as a single injection? Select all that apply.​

Rapid-acting insulin Short-acting insulin

Which insulin is short-acting?

Regular

The nurse is caring for a young adult admitted to the intensive care unit (ICU) with pneumonia and hyperglycemia. The nurse should first address the client's __________, followed by the client's __________.

Serum glucose Temperature

Which insulin formulations are currently available in the U.S.? Select all that apply.

Short-acting Intermediate-acting Rapid-acting Long-acting

Regular insulin is which type of insulin?

Short-acting insulin

The nurse administering insulin to a client with diabetes mellitus type 1 is responsible for knowing what key information about the drug? Select all that apply.

Strength Peak Onset Duration

What is the route of administration for intermediate-acting insulin?

Subcutaneous

What is the route of administration of lispro?

Subcutaneous

Regular insulin may be administered via what routes? Select all that apply.

Subcutaneous Intravenous

Which classes of medication are used to treat diabetes mellitus (DM) type 2? Select all that apply.​

Sulfonylureas Dipeptidyl peptidase-IV (DPP-IV) inhibitors Thiazolidinediones Biguanides Glucagon-like peptide-1 (GLP-1) agonists

In which situation is it appropriate to administer the first dose of lispro insulin to a client newly diagnosed with diabetes mellitus type 1?​

The meal tray is present at the time of administration.

Under which conditions should the nurse withhold (not give) a client's prescribed insulin lispro? Select all that apply.​

The meal tray will arrive 2 hours after insulin administration. The client can have the meal tray delivered at their convenience. The client is not allowed to eat or drink until after a procedure.

When teaching a client about their newly prescribed long-acting insulin, the nurse should encourage the client to eat within what time frame around their daily injection?

The next time they are hungry.

The nurse is caring for a client who received intermediate-acting insulin at 0730. It is now 1300, and the client tells the nurse they feel weak, have the shakes, and their heart is racing. The nurse notes the client is diaphoretic, as well. After seeing the client's lunch tray sitting at the bedside with most of the food untouched, the nurse should understand that the clinical manifestations are most likely a result of which factors? Select all that apply.

The peak effect of the intermediate-acting insulin. Skipping a meal since the intermediate-acting insulin was administered.

After administering insulin glargine to a client at 2100, the nurse should anticipate that the client's serum glucose level may start to decrease at what time?

The same day between 2200 and 2300.

The nurse is preparing to administer 50 units of regular, U-100 insulin. Which syringe should be used?

U-100

While preparing the pre-breakfast insulin dose for a client, the nurse should question which aspect of the healthcare provider's prescription? Select one (1) option only.​ Insulin glargine 55 units with 10 units lispro subcutaneously as one injection daily before bed.

With 10 units lispro