Insulin

NPH peak: - no peak - 3 to 6 hrs - 4 to 12 - 1 to 3

4 to 12

Which would the nurse identify as an effect of somatostatin on blood glucose? -Decreased glucagon release -Increased insulin release -Increased GI emptying -Decreased insulin sensitivity

Decreased glucagon release (Somatostatin decreases glucagon release. Somastatin decreases insulin release. Somastatin slows GI emptying. Somastatin does not affect insulin sensitivity.)

A client has been noncompliant with the diabetic medication regimen and develops diabetic ketoacidosis. Which would the nurse assess? -Deep respirations -Edema -Decreased blood glucose levels -Sour breath odor

Deep respirations (Deep respirations are seen with diabetic ketoacidosis as the body attempts to rid itself of high acid levels. The client with diabetic ketoacidosis is typically dehydrated. Blood glucose levels are typically elevated with diabetic ketoacidosis. A fruity breath odor is indicative of diabetic ketoacidosis.)

Which insulin would the nurse need to administer as a separate injection if the order also included NPH insulin? -Glargine -Regular -Lente -Lispro

Glargine (Insulin glargine cannot be mixed in solution with any other insulin.)

Which one of these drugs would you hold when need IV contrast? - Rosiglitazone - Glyburide - Exenatide - Metformin

Metformin

Which oral antidiabetic can be given to peds, 10 and older? - Metformin - Exenatide - Glyburide - Rosiglitazone

Metformin

Glipizide should be taken: - before meals - with breakfast - after meals - without food

before meals (She said in class)

Glargine peak: - 3 to 6 hrs - 4 to 12 hrs - 1 to 3 hrs - no peak

no peak

A patient has edema, fluid retention, and chronic heart failure, which drug would you question the order for: - exenatide - glipizide - rosiglitazone - metformin

rosiglitazone

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 assists glucose molecules to enter the cells of muscle and fat tissues." -"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 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.)

During a teaching session on the care of the diabetic client, the nurse should make which statement to explain the differences in insulin? -"Insulin is prescribed based on the insurer's criteria for reimbursement." -"Insulin is prescribed based on the client's age." -"Insulins have different onsets and durations of action." -"Insulin type is matched with the appropriate oral hypoglycemic agent."

"Insulins have different onsets and durations of action." (When insulin therapy is indicated, the health care provider may choose from several preparations that vary in composition, onset, duration of action, and other characteristics. Insulin is not prescribed based solely on cost. Insulin is not prescribed based solely on the client's age. Insulin is not usually matched with oral hypoglycemic agents.)

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.) -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. -Watch the client draw up and administer her insulin. -Reinforce instructions on dealing with hypoglycemia. -Encourage the client to check her blood glucose every hour.

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 home care nurse would assist the client and family to know how to plan meals that meet the needs of the client and the family. The nurse would also want to assure that the client knows how to administer insulin correctly and would need to make sure that the client understands how to deal 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.) -Lose 10-15 pounds. -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. -If you skip a meal, increase your next insulin dosage.

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. (The client should be encouraged to follow a prescribed diet, know how many calories are allowed, and know how to do food exchanges. The client should follow an established meal schedule and avoid skipping meals. If a meal is skipped, the next insulin dose may need to be lowered, not raised. The client should be encouraged to use artificial sweeteners and to read food labels carefully. The client should avoid alcohol, dieting, and commercial weight-loss products.)

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 -Between 10 AM and 12 noon -Between 2 PM and 4 PM -Between 12 noon and 8 PM

Between 8:30 AM and 9:30 AM (With insulin lispro, peak effects would occur in 30 to 90 minutes or between 8:30 AM and 9:30 AM. Regular insulin peaks in 2 to 4 hours, so the nurse would be alert for signs and symptoms of hypoglycemia at this time, which would be between 10 AM and 12 noon. With insulin detemir, peak effects would occur in 6 to 8 hours, or between 2 PM and 4 PM. With NPH insulin, peak effects would occur in 4 to 12 hours, or between 12 noon and 8 PM.)

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 preparing the syringe with insulin, the nurse should then have the medication and dosage checked by a second nurse to make sure that it is correct. It is not necessary to recheck the client's blood sugar again. It is important to know when the client will be eating again; make sure that it is within the next 30 minutes. However, this is not the nurse's next step. Then the nurse will administer the insulin to the client.)

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 is in good glycemic control. -Client's average blood glucose is above normal. -Client's blood glucose levels are not consistent. -Client's blood glucose demonstrates longstanding hypoglycemia.

Client's average blood glucose is above normal. (The American Diabetes Association (ADA) suggests a target A1C of less than 7%. A1C should be measured every 3 to 6 months. An A1C of 9 indicates that the client's average blood glucose is consistently above normal.)

What distinguishing characteristic is associated with type 1 diabetes? -Blood glucose levels can be controlled by diet. -Exogenous insulin is required for life. -Oral agents can control blood sugar. -The disease always starts in childhood.

Exogenous insulin is required for life. (Type 1 diabetes will result in eventual destruction of beta cells, and no insulin is produced. 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.)

The nurse is providing teaching to a client with type 1 diabetes. The client requires additional teaching when he learns that his insulin needs may increase because of what condition? (Select all that apply.) -Exercise -Fever -Anxiety -Decreased food intake -Stress

Fever Anxiety Stress (Exercise and decreased food intake decrease insulin needs; fever, anxiety, and stress all will increase insulin needs for the client with type 1 diabetes.)

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 the insulin via insulin pump. -Administer oral antidiabetics to the patient. -Give oral fluids or candy.

Give oral fluids or candy. (The nurse should administer oral fluids or candy to the hypoglycemic patient with swallowing and gag reflexes. If the patient is unconscious the nurse should administer glucose or glucagon parenterally. The nurse should administer insulin through an insulin pump to special categories of diabetic patients, such as pregnant women with diabetes and renal transplantation. Oral antidiabetic drugs are administered to patients with type 2 diabetes.)

The nurse is explaining the action of exenatide to a patient. Which would the nurse include? -Increase in insulin release -Increase in glucagon release -Increase in GI emptying -Increase in protein building

Increase in insulin release (Exenatide is an incretin mimetic, which increases insulin release, decreases glucagon release, stimulates the satiety center, and slows GI emptying.)

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) -Isophane insulin suspension (Novolin N) -Insulin glargine (Lantus) -Insulin zinc suspension (Humulin L) -Insulin Lispro (Humalog)

Insulin aspart (NovoLog) Insulin lispro (Humalog) (Insulin aspart (NovoLog) and insulin lispro (Humalog) are rapid-acting insulins with a duration of one to five hours depending on the individual product.)

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 aspart (NovoLog) -Insulin lispro (Humalog) -Insulin glargine (Lantus) -Insulin detemir (Levemir) -Insuline glulisine (Apidra)

Insulin glargine (Lantus) Insulin detemir (Levemir) (Insulin glargine (Lantus) and insulin detemir (Levemir) are long-acting insulins with a duration of 24 hours.)

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? -Administer regular insulin subcutaneously. -Give 8 oz orange juice. -Place glucose gel between the gums and cheek. -Raise the head of the bed.

Place glucose gel between the gums and cheek. (The client is experiencing hypoglycemia, which presents very suddenly and has symptoms such as fatigue, weakness, nervousness, agitation, confusion, and headache. It may lead to convulsions and unconsciousness. The client's skin is pale, moist, cool, and diaphoretic and the client may report hunger or nausea. The treatment is to give the client something with sugar. The glucose gel would absorb through the client's mucous membranes and would be the optimal way to provide the client with sugar, since the client is no longer able to talk. Eight ounces of orange juice is too much. The client does not need the insulin, which is used for hyperglycemia. Symptoms of this are gradual and include drowsiness, dim vision, thirst, nausea, abdominal pain, loss of appetite, rapid and weak pulse, acetone breath, and skin that is dry, flushed, and warm. Raising the head of the bed is not indicated because there is no evidence of difficulty breathing.)

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? -Inject a prescribed dose of insulin as soon as you suspect the reaction is occurring. -Stay calm and still until the reaction subsides. -Notify your health care provider immediately. -Take an oral dose of some form of glucose as soon as possible.

Take an oral dose of some form of glucose as soon as possible. (The initial action of the client should be to take some form of oral glucose. It would also be appropriate to call the provider, but this will delay self-treatment and should be done after the administration of the glucose. Injecting insulin would cause further harm to the client and is not an option. It is good to stay calm, but the reaction will not subside without intervention.)

The nurse assesses a client's blood glucose level after administering insulin. Which result would the nurse interpret as indicative of severe hypoglycemia? -34 mg/dL -72 mg/dL -65 mg/dL -48 mg/dL

34 mg/dL (Blood glucose levels below 40 mg/dL are indicative of severe hypoglycemia.)

Regular insulin duration: - 24 hrs - 2 to 5 hrs - 3 to 5 hrs - 6 to 12 hrs

6 to 12 hrs

Glargine onset - 60 to 70 min - < 15 min - 1 to 1.5 hrs - 30 to 60 min

60 to 70 min

Lispro onset: - < 15 min - 30 to 60 min - 1 to 2 hrs -10 to 20 min

< 15 min

exenatide action: - increase insulin sensitivity - mimics incretins, signals pancreas to secrete insulin - decrease intestinal absorption of glucose - mobilizes glucose

mimics incretins, signals pancreas to secrete insulin

Glipizide and glyburide as sulfonylureas have these commonalities (select all that apply): - no alcohol (disulfiram) - pancreatitis - photosensitivity - fluid retention - PO

no alcohol photosensitivity PO

Some contraindications for exenatide include but are not limited to (select all that apply): - Pregnancy and lactation - alcohol consumption - heart failure - pediatrics - patient is not eating

pregnancy and lactation pediatrics patient is not eating

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 -the past 7 to 10 days -the past 1 or 2 months -the past 12 to 24 hours

the past 3 or 4 months (Glycosylated hemoglobin measures glucose control over the past 3 to 4 months. When blood glucose levels are high, glucose molecules attach to hemoglobin in the red blood cell. The longer the hyperglycemia lasts, the more glucose binds to the red blood cell and the higher the glycosylated hemoglobin. This binding lasts for the life of the red blood cell (about 4 months) so the other time frames would not be accurate.)

Aspart duration: - 3 to 5 hrs - 6 to 12 hrs - 24 hrs - 5 to 8 hrs

3 to 5 hrs (not to be confused with ASSPIT)

Which would a nurse identify as an example of a sulfonylurea? -Glyburide -Metformin -Acarbose -Xenatide

Glyburide (Glyburide is an example of a sulfonylurea. Metformin is classified as a biguanide. Acarbose and miglitol are alpha-glucosidase inhibitors.)

NPH onset: - 10 to 20 min - 1 to 1.5 hrs - 1 to 2 hrs - < 15 min

1 to 1.5 hrs

Detemir onset: - 30 to 60 min - 1 to 2 hrs - 10 to 20 min - 60 to 70 min

1 to 2 hrs

Aspart peak time: - 2 to 4 hrs - 4 to 12 hrs - 1 to 3 hrs - no peak

1 to 3 hrs (Haha aspart)

Aspart onset time: - 30 min to 1hr - 10 to 20 min - 1 to 2 hrs - < 10min

10 to 20 min (I made this no rationale haha)

Regular insulin peak - 2 to 4 hrs - 1 to 3 hrs - 4 to 12 hrs - no peak

2 to 4 hrs

Lispro duration: - 6 to 12 hrs - 2 to 5 hrs - 24 hrs - 5 to 8 hrs

2 to 5 hrs

Detemir peak: - 3 to 6 hrs - no peak - 1 to 3 hrs - 30 to 90 min

3 to 6 hrs

Detemir duration: - 6 to 12 hrs - 24 hrs - 5.7, to 23.3 hrs - 2 to 5 hrs

5.7 to 23.3 hrs

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 -Accumulation and hyperglycemic reactions -Decreased absorption of the sulfonylurea -Hypersensitivity to sulfonylurea

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.)

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 -Lente -Detemir -Lispro

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 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 one month -Every two weeks -Every 5-7 days -Every 1-3 days

Every 1-3 days (For an insulin pump, the needle is changed every 1 to 3 days.)

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? -Jet injector -Insulin pen -External pump -Subcutaneous injection

Subcutaneous injection (Although other delivery systems are available for insulin administration such as the jet injector, insulin pen, and external pump, subcutaneous injection remains the primary delivery system)

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 -Insulin pen -Jet injector -Implantable infusion pump

Subcutaneous injection (Subcutaneous injection currently is the most common method for administering insulin.)

The two oral antidiabetics that have lowered risk for hypoglycemia are: - glipizide, glyburide - exenatide, rosiglitazone - metformin, glyburide - glipizide, aspart

exenatide, rosiglitazone

Glyburide is taken: - before meals - after lunch - with breakfast - 1 to 2 times a day

with breakfast

Glargine duration - 5.7 to 23.3 hrs - 3 to 5 hrs - 24 hrs - 6 to 12 hrs

24 hrs

NPH duration - 24 hrs - 6 to 12 hrs - 2 to 5 hrs - 6 to 8 hrs

24 hrs

The nurse is aware that premixed insulins (those that contain both regular and NPH insulin) are least effective in what type of client? -Client who has difficulty controlling his diabetes -Client who strictly monitors his diet -Client who encounters problems drawing up insulin into the syringe -Client who has difficulty reading the markings on the syringes

Client who has difficulty controlling his diabetes (Premixed insulins are least effective for clients who have difficulty controlling their diabetes, because it is difficult to individualize the dosages of each type of insulin. It is helpful to clients to use premixed insulin if they have difficulty drawing up their insulin, or seeing the markings on the syringe. The strict monitoring of the diet assists in keeping diabetes in good control.)

A nurse is caring for a patient diagnosed with type 2 diabetes. What should the nurse inform the patient are risk factors associated with type 2 diabetes? -Young age -Regular exercise -Obesity -Polyuria

Obesity (The nurse informs the patient that obesity is a risk factor associated with type 2 diabetes. Young age and regular exercise are not risk factors for type 2 diabetes. Polyuria is a symptom of diabetes and not a risk factor leading to type 2 diabetes.)

The nurse monitoring a client receiving insulin aparte (Novolog) 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 -Insulin glargine (Lantus) -Hard candy -Insulin detemir (Levemir)

Orange or other fruit juice Glucose tablets Hard candy (Methods of terminating a hypoglycemic reaction include the administration of one or more of the following: orange or other fruit juice, hard candy or honey, glucose tablets, glucagon, or glucose 10 percent or 50 percent IV.)

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? -Infection -Impaired glucose tolerance -Poor insulin injection technique -Widespread changes in the blood vessels

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.)

A nurse is preparing to administer a rapid-acting insulin. Which medication would the nurse most likely administer? -insulin lispro -insulin glargine -insulin detemir -isophane insulin suspension

insulin lispro (Insulin lispro is an example of a rapid-acting insulin. Insulin glargine and insulin detemir are long-acting insulin. Isophane insulin suspension is an intermediate-acting insulin.)

Side effects of metformin include but are not limited to (select all that apply): - edema - lactic acidosis - pancreatitis - renal - prominent GI symptoms

lactic acidosis renal prominent GI symptoms

Which oral antidiabetic would you probably use first for type 2 diabetics: - glipizide - exenatide - metformin - rosiglitazone

metformin

What type of insulin will most likely be administered intravenously to a client with a blood glucose level over 600 mg/dL (33.33 mmol/L)? -NPH insulin -lente insulin -ultralente insulin -regular insulin

regular insulin (Regular insulin has rapid onset of action and can be given via IV. It is the drug of choice for acute situations, such as diabetic ketoacidosis. Isophane insulin (NPH) is used for long-term insulin therapy. Lente insulin is an intermediate-acting insulin. Ultralente insulin is a long-acting insulin.)

When should exenatide be taken: - with breakfast - not with food - after lunch - within 60 minutes of breakfast and dinner

within 60 minutes of breakfast and dinner

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. -More insulin is needed than that which the client can produce naturally. -The client most likely does not exercise enough to control his glucose levels.

Insulin is needed because the beta cells of the pancreas are no longer functioning. (Insulin is needed in type 1 diabetes because the beta cells of the pancreas are no longer functioning. With type 2 diabetes, insulin is produced, but perhaps not enough to maintain glucose control or the insulin receptors are not sensitive enough to insulin.)

Which would be appropriate to include in teaching a client with type 2 diabetes? -Until you need to start insulin injections, you do not have to check your blood sugar. -Clients with type 2 diabetes always progress to insulin injections if they do not follow dietary guidelines. -It is possible with weight loss and exercise to discontinue the use of antidiabetic medication. -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. (Exercise is perhaps the best therapy for the prevention of both type 2 diabetes and the metabolic syndrome. Exercise is an extremely strong hypoglycemic agent.)

The nurse who has admitted a client with diabetic ketoacidosis should look for what assessment findings that are consistent with this diagnosis? (Select all that apply.) -Blood glucose 191 mg/dL -Ketones in the urine -Somnolence -Flushed, dry skin -Rectal pressure

Ketones in the urine Flushed, dry skin (Signs/symptoms of DKA include: elevated blood glucose levels (greater than 200 mg/dL); headache; increased thirst; epigastric pain; nausea and vomiting; hot, dry, flushed skin; restlessness; and diaphoresis. The client would not experience somnolence or rectal pressure.)

Which would be least appropriate when administering insulin by subcutaneous injection? -Using a 25 gauge 1/2-inch needle -Inserting the needle at a 45-degree angle -Injecting the insulin slowly -Massaging the site after removing the needle

Massaging the site after removing the needle (Gentle pressure should be applied to the injection after the needle is withdrawn. Massaging could contribute to erratic or unpredictable absorption.)

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? -Assess the skin for ulcers, cuts, and sores. -Observe the patient for hypoglycemic episodes. -Monitor the patient for lipodystrophy. -Document family medical history.

Observe the patient for hypoglycemic episodes. (As the ongoing assessment activity, the nurse should observe the patient for hypoglycemic episodes. Documenting family medical history and assessing the patient's skin for ulcers, cuts, and sores on the body is a pre-administration assessment activity performed by the nurse. Lipodystrophy occurs if the sites of insulin injection are not rotated.)

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 walk two blocks to school every day." -"I am on the middle school track team." -"We live in a two-story house." -"My mother is going to give me my insulin."

"I am on the middle school track team." (Because the client is on the track team, she will have increased exercise at various times that will require increased insulin and special instructions related to hypoglycemia that may come hours after she has ceased exercising. Walking two blocks every day and walking up stairs would not be considered increased physical exercise and would not be a factor. Wanting to have her mother administer the insulin is not uncommon for this age client, and the nurse would normally instruct both the mother and the daughter in the administration of the drug.)

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 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." -"I should not administer the insulin if it is cloudy."

"The medication will peak in 3 hours." (Insulin glargine (rDNA) is characterized by a chemical structure that regulates its release from the SC tissue into the circulation, providing a relatively constant glucose-lowering effect with no pronounced peak of action over a 24-hour period. Glargine, unlike NPH, is a clear insulin, similar to regular insulin in its appearance. Extreme caution must be used not to confuse glargine with regular insulin because serious adverse effects, including hypoglycemia, can occur. Glargine must not be diluted or mixed with any other insulin or solution because its onset of action may be delayed, and the solution will become cloudy. Insulin glargine is administered subcutaneously once daily at bedtime.)

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 -Anorexia -Impaired mental functioning -Hallucinations -Lethargy

-Irritability -Impaired mental functioning -Lethargy (In young children, hypoglycemia may be manifested by changes in behavior, including severe hunger, irritability, and lethargy. In addition, mental functioning may be impaired in all age groups, even with mild hypoglycemia. Anytime hypoglycemia is suspected, blood glucose should be tested.)

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 -insulin lispro -insulin aspart -isophane insulin suspension

-insulin glargine (Insulin glargine is an example of a long-acting insulin. Insulin lispro and insulin aspart are rapid-acting insulin. Isophane insulin suspension is an intermediate-acting insulin.)

Regular insulin onset: - 1 to 2 hrs - 10 to 20 min - 30 to 60 min - 60 to 70 min

30 to 60 min

Lispro peak: - 4 to 12 hrs - 3 to 6 hrs - no peak - 30 to 90 min

30 to 90 min

Which strategy will NOT increase the therapeutic effect of insulin? -All insulin should be stored in a refrigerator but never frozen. -Insulin should be administered in the subcutaneous tissue. -Regular insulin should be administered 30 minutes before meals. -Blood glucose levels should be monitored several times per day.

All insulin should be stored in a refrigerator but never frozen. (Store opened vials of regular insulin at room temperature. Extra supplies are stored in the refrigerator, not the freezer. Extreme temperatures (<2°C or >30°C) should be avoided to prevent the loss of maximum function. Administer regular insulin with an insulin syringe into an appropriate subcutaneous site. Regular insulin is administered about 30 to 60 minutes before eating. To promote regular absorption, one anatomic area should be selected for regular insulin injections (e.g., the abdomen). Frequent monitoring of blood glucose by fingersticks and periodic determinations of hemoglobin A1C levels help determine the therapeutic effect of insulin and overall consistency of diabetic control.)

A nurse is assigned to administer glargine to a patient at a health care facility. What precaution should the nurse take when administering glargine? -Administer glargine via IV route. -Avoid mixing glargine with other insulin. -Shake the vial vigorously before withdrawing insulin. -Administer insulin that has been refrigerated.

Avoid mixing glargine with other insulin. (When administering glargine to the patient, the nurse should avoid mixing it with other insulin or solutions. It will precipitate in the syringe when mixed. If glargine is mixed with another solution, it will lose glucose control, resulting in decreased effectiveness of the insulin. Glargine is administered via SC once daily at bedtime. The nurse should not shake the vial vigorously before withdrawing insulin. The vial should be gently rotated between the palms of the hands and tilted gently end-to-end immediately before withdrawing the insulin. The nurse administers insulin from vials at room temperature. Vials are stored in the refrigerator if it is to be stored for about three )

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 -Blurred vision -Fruity breath -Flushing of the face

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.(I don't know how you observe blurred vision, "Hey, hey you, your vision looks blurry))

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? -Release of glucagon from the cells -Entry of glucose into the cells -Interruption of glucose movement across the membrane -Storage of glucagon in the cells

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.)

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.) -Glipizide -Glyburide -Tolazamide -Pramlintide -Repaglinide

Glipizide Glyburide (Glipizide is a second generation sulfonylurea. Glyburide is a second generation sulfonylurea. Tolazamide is a first generation sulfonylurea. Pramlintide is a human amylin agent. Repaglinide is a meglitinide agent.)

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.) -Increased thirst -Increased urination -Headache -Confusion -Diaphoresis

Headache Confusion Diaphoresis (The symptoms of hypoglycemia include fatigue, weakness, nervousness, agitation, confusion, headache, diplopia, convulsion, dizziness, unconsciousness, hunger, nausea, diaphoresis, and numbness or tingling of the lips or tongue.)

The nurse is caring for a client who is taking a thiazide diuretic, a corticosteroid, and estrogens. The nurse understands that this client is at risk for what condition? -Hypoglycemia -Pulmonary hypertension -Congestive heart failure -Hyperglycemia

Hyperglycemia (Renal insufficiency may increase risks of adverse effects with antidiabetic drugs, and treatment with thiazide diuretics, corticosteroids, estrogens, and other drugs may cause hyperglycemia, thereby increasing dosage requirements for antidiabetic drugs.)

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? -Bradycardia -Lipodystrophy -Hypoglycemia -Hypotension

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.)

When administering insulin, what would be most appropriate? -Shake the vial vigorously to ensure thorough mixing before drawing up the dose. -Firmly spread the skin of the area of the intended site of injection. -Insert the needle at a 45-degree angle for injection. -Massage the injection site firmly after removing the needle and syringe.

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. -Keep prefilled syringes horizontally. -Check for symptoms of myalgia or malaise. -Do not administer insulin kept at room temperature.

Inspect the previous injection site for inflammation. (The nurse should check the previous injection site before administering each insulin dose. The injection sites should be rotated to prevent lipodystrophy. Prefilled syringes should not be kept horizontally; they should be kept in a vertical or oblique position to avoid plugging the needle. The nurse checks for symptoms of myalgia or malaise when administration of metformin leads to lactic acidosis. Insulin should be kept at room temperature for administration. Insulin is refrigerated if it needs to be stored for up to three months for later use.)

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) -Isophane insulin suspension (Novolin N) -Insulin glargine (Lantus) -Insulin zinc suspension (Humulin L) -Insulin lispro (Humalog)

Insulin aspart (NovoLog) Insulin lispro (Humalog) (Insulin aspart (NovoLog) and insulin glulisine (Apidra) are rapid-acting insulins with a duration of one to five hours depending on the individual product.)

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 stimulates insulin release from the beta cells of the pancreas. -It reduces glucose output from the liver. -It decreases intestinal absorption of glucose and improves insulin sensitivity. -It reduces postprandial glucose levels substantially in combination with insulin.

It decreases intestinal absorption of glucose and improves insulin sensitivity. (Metformin decreases the intestinal absorption of glucose and improves insulin sensitivity, while glyburide works by stimulating insulin release from the beta cells of the pancreas and reducing glucose output from the liver. On the other hand, postprandial glucose levels substantially are reduced by acarbose and miglitol when administered either alone or in combination with insulin or sulfonylurea.)

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? -Deficient fluid volume -Lactic acidosis -Fluid overload -Hyperkalemia

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.)

A client diagnosed with diabetes is demonstrating slow, deep respirations and is difficult to arouse. Which nursing intervention is directed specifically at treating this serious complication of diabetes? -Assessing orientation and level of alertness -Maintaining adequate intravenous fluid delivery -Monitoring for a fruity breath -Providing respiratory assistance as prescribed

Maintaining adequate intravenous fluid delivery (Hyperglycemia, or high blood sugar, results when there is an increase in glucose in the blood. Clinical signs include Kussmaul respirations, impaired orientation and alertness, and the presence of a fruit breath resulting for a build up ketones being excreted via the lungs. Fluid and electrolytes are lost through the kidneys causing dehydration that must be addressed through the introduction of adequate IV fluids. The remaining options are appropriate assessment activities but do not address the focus of the question; a specific intervention.)

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? -Alcohol should be limited and taken only with meals. -Daily caloric intake should be increased by 200 calories. -Daily snacks should increase protein intake. -Meals should be eaten at regular times.

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 female client is diagnosed with type 1 diabetes. She suddenly reports feeling weak, shaky, and dizzy. What should the nurse's first response be? -Administer 1 amp of 50% dextrose IV. -Administer 10 units of regular insulin subcutaneously. -Perform a blood sugar analysis. -Have the client drink a glass of orange juice.

Perform a blood sugar analysis. (As long as the client is awake and verbally responsive, check the blood glucose level first. Hypoglycemia can make the client feel weak, confused, irritable, hungry, or tired. Clients may also report sweating or headaches. If the client has any of these symptoms, check the blood glucose. If the level is 70 mg/dL or below, have the client consume 3 or 4 glucose tablets; 1 serving of glucose gel; 1/2 cup of any fruit juice; 1 cup of milk; 1/2 cup of a regular soft drink; several pieces of hard candy; or 1 tablespoon of sugar or honey.)

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. -Lente. -Regular. -Ultralente.

Regular. (In general, regular insulin, a short-acting insulin, is used with major surgery or surgery requiring general anesthesia. IV administration of insulin is preferred because it provides more predictable absorption than subcutaneous injections. Only regular insulin is administered IV.)

A nurse is instructing a patient in the administration of regular insulin by the subcutaneous route. Which strategy would the nurse suggest if the goal is to promote absorption of the regular insulin? -Rotate injection sites by using the arm one day, the stomach the next day, and the thigh the day after and then repeating the cycle. -Select one injection site for regular insulin injections and use it exclusively. -Administer the medication 30 to 60 minutes after a meal. -Select one anatomic area for regular insulin injections and then use serial locations within that area.

Select one anatomic area for regular insulin injections and then use serial locations within that area. (To promote the absorption of regular insulin, one anatomic area should be selected for subcutaneous injections. Serial locations within that anatomic area are then chosen to rotate the exact injection site. Injection sites should not be rotated by using different anatomic areas each day, because this would substantially change the absorption of the insulin and the patient's blood glucose levels. Using one injection site regularly may lead to lipodystrophy. Regular insulin is administered about 30 to 60 minutes before eating a meal, not after.)

Exenatide is taken by this route: - PR, qid - PO, bid - Subcutaneously, Bid - IVPB, daily

Subcutaneously, bid

The nurse is providing care for several clients who have diabetes. Which client should the nurse monitor most closely for signs and symptoms of hypoglycemia? -a client who received 12 units of Humulin R 45 minutes ago -a client who received 12 units of metformin minutes ago -a client whose most recent blood glucose level was 150 mg/dL -a client whose type 2 diabetes was diagnosed one week ago

a client who received 12 units of Humulin R 45 minutes ago (Administration of regular insulin will create a greater risk for hypoglycemia than metformin, which is used in the treatment of type 2 diabetes. A blood glucose level of 150 mg/dL is nominally elevated, and creates no particular risk for "rebound" hypoglycemia. Clients whose diabetes has been recently diagnosed must be monitored closely, but this does not mean that the client faces a particular risk for hypoglycemia.)

Which factor would prohibit the administration of glipizide? -a diagnosis of hypertension -the ingestion of carbohydrates -allergy to sulfonamides -increase in alkaline phosphatase

allergy to sulfonamides (Sulfonylureas are contraindicated in clients with hypersensitivity to them, with severe renal or hepatic impairment, and who are pregnant. A diagnosis of hypertension does not cause contraindication of sulfonylureas. The client should consume carbohydrates in association with the oral hypoglycemic agent. An increase in alkaline phosphatase does not result in the contraindication of glipizide.)

A nurse at a health care facility is caring for a client who has been prescribed insulin for the first time. Which preadministration assessments should the nurse perform before the first dose of insulin is given? -assess the dental health of the client -assess for hypoglycemic episodes in general -assessment of the skin -assess the hearing ability of the client

assessment of the skin (The nurse should perform a general assessment of the skin, mucous membranes, and extremities of the client as a preadministration assessment before giving the first dose of insulin. The nurse need not assess for hypoglycemic episodes before administration of the first dose of insulin since the client has not received any insulin or oral antidiabetic drugs. The nurse need not assess the dental health or the hearing ability of the client as these are not pertinent to insulin administration.)

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? -hypoglycemia -hyperglycemia -nausea and vomiting -rash and fever

hyperglycemia (Corticosteroids increase insulin needs, so the client may develop hyperglycemia.)

Side effects of exenatide include: - slows gastric emptying, pancreatitis - photosensitivity, disulfiram - fluid retention, edema - metallic taste, lactic acidosis

slows gastric emptying, pancreatitis

The nurse is caring for a client taking insulin. The nurse realizes the client is experiencing symptoms of hypoglycemia when the client displays: -increased pulse rate and fruity smelling breath. -decreased respiratory rate and hot, dry skin. -weakness, sweating, and decreased mentation. -increased thirst and increased urine output.

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.)