NURS 310 Diabetes Medication
A patient with type 2 DM that is controlled with diet and metformin (Glucophage) also has severe rheumatoid arthritis (RA) and has been prescribed prednisone (Deltasone) to control inflammation. What is most likely to occur? a. Development of acute hypoglycemia because of the RA exacerbation b. Development of a rash caused by metforminprednisone interactions c. Needing a diet higher in calories while receiving prednisone d. Prescription of insulin on a sliding scale while on prednisone
D
What is an appropriate outcome for drug therapy with metoclopramide (Reglan) for a patient with DM? a. Alert and oriented ×3 b. No adventitious lung sounds c. Palpable peripheral pulse d. Soft, nondistended abdomen
D
A 132-pound patient is prescribed an intravenous infusion of regular insulin at 0.1 units/kg/hr, which calculates to 6 units per hour. The insulin comes mixed as a solution of 25 units in 100 mL of normal saline. The IV pump calibration is in milliliters per hour. What rate should the nurse program for the continuous IV insulin drip?
24 ml/hr
A nursing student asks an emergency department (ED) nurse why premixed IV regular insulin solutions are not available in the ED as a stock drug. What is the best explanation by the nurse? a. Insulin can be absorbed into the plastic, altering the concentration. b. Insulin is affected by light, and IV bags are clear. c. Insulin rapidly biodegrades when mixed with a diluent. d. The appropriate insulin diluent cannot be refrigerated.
B
A patient who has type 2 DM has been unable to follow the recommended diet and exercise regimen. He tries to alter his laboratory test results by eating less than usual before having blood testing performed. Which test would be most accurate for this patient because it evaluates his glucose control over the past 3 months? a. Fasting glucose b. A1c c. Postprandial glucose d. Two-hour glucose tolerance
B
The college health nurse is caring for a type 2 DM college student who was brought to the health clinic after getting drunk. The student is prescribed metformin (Glucophage) 850 mg once a day. The nurse assesses the student. What assessment would be of most concern to the nurse? a. Dorsalis pedis pulse difficult to palpate b. Respirations 32 breaths per minute and deep c. Pulse 100 beats/min d. Severe frontal headache
B
The nurse is caring for a patient who is NPO for a diagnostic test. Which dose of insulin should be administered, if ordered, even if the patient is not eating? a. 8:00 am SMBG 100 mg/dL; prescribed insulin aspart (NovoLog) 5 units and NPH (NovoLog) 34 units b. 8:00 am SMBG 190 mg/dL; prescribed regular insulin (Humulin R) 4 units per sliding scale coverage c. 8:00 am SMBG 110 mg/dL; prescribed insulin detemir 26 units d. 8:00 am SMBG 80 mg/dL; prescribed NPH insulin (Novolin N) 34 units
B
Which assessment change from yesterday morning in a patient who is prescribed pioglitazone (Actos) would be of most concern to the nurse? a. Abdominal pain and two loose stools this morning b. Crackles throughout lung fields and 21 ⁄2-pound weight gain c. Decrease in BP from 130/82 to 118/78 mm Hg and pulse drop from 82 to 74 beats/min d. Temperature 102.4° F and cough
B
The nurse assesses for which symptom of the electrolyte imbalance that is most likely when a patient is receiving large doses of insulin? a. Muscle weakness and constipation b. Restlessness and irritability c. Spasm of the wrist and fingers when circulation of the upper arm is constricted for several minutes d. Twitching of the facial nerve when the face is tapped over the nerve.
A
Which complication of diabetes causes the most deaths? a. cardiovascular effects b. hypoglycemia c. ketoacidosis d. renal damage
A
It would be a priority for the nurse to respond to which symptoms if exhibited by a patient who is receiving insulin therapy for diabetes? a. Fatigue and blurred vision b. Perineal itching and copious urine c. Profuse sweating and difficult to arouse d. Thirst and constant hunger
C
The nurse has done an initial assessment on assigned patients and is preparing to administer prescribed insulin. All patients are alert and oriented. It is 8:07 am, and breakfast trays are scheduled to arrive at 8:45 am. To which patient should the nurse administer the insulin first? a. 8:00 am SMBG 100 mg/dL; prescribed insulin aspart (NovoLog) 5 units b. 8:00 am SMBG 110 mg/dL; prescribed insulin glulisine (Apidra) 7 units c. 8:00 am SMBG 80 mg/dL; prescribed NPH insulin (Novolin N) 34 units d. 8:00 am SMBG 90 mg/dL; prescribed regular insulin (Humulin R) 5 units
C
What special administration techniques must the nurse use when administering NPH insulin? a. Never mix with another insulin. b. Administer this insulin only at bedtime. c. Roll the vial gently to mix particles in solution. d. When mixing with another insulin, draw the NPH into the syringe first.
C
What would warrant the nurse not administering repaglinide (Prandin) and consulting the prescriber? a. Fasting blood glucose 95 mg/dL b. Glycosylated hemoglobin (A1c) 5.5% c. Patient is NPO for a colonoscopy d. Patient is scheduled for hemodialysis at 1000
C
When performing the initial morning assessment on a diabetic patient, the nurse notes that the patient is diaphoretic and confused. The nurse checks the SMBG, which is 37 mg/dL. What is the priority assessment before administering orange juice? a. Blood pressure b. Deep tendon reflexes c. Swallowing reflex d. Temperature
C
Which laboratory test result increases the risk that a patient who is prescribed glimepiride (Amaryl) might experience hypoglycemia? a. ALP 142 international units/L b. BUN 24 mg/dL c. eGFR 42 mL/min d. G6PD 2.4 U/g of hemoglobin
C
A blind, diabetic, hospitalized patient is receiving acarbose (Precose) 50 mg 3 times a day with meals. Because of possible adverse effects of the drug, the patient is most likely at risk for which nursing problem? a. Activity intolerance b. Ineffective coping c. Injury d. Powerlessness
C
A teacher reports to the school nurse that a 6-year old has been using the restroom more often than usual. Which action would be most valuable at this time for assessing the possibility of type 1 diabetes mellitus (DM)? a. Asking the child if his or her parents are have diabetes b. Asking the child what he or she normally eats each day c. Comparing the child's current weight to previous weight for weight loss d. Performing a self-monitoring of blood glucose (SMBG) on the child
C
After administration of glucagon for severe hypoglycemia, what is the priority goal of therapy? a. Correct acidosis. b. Correct cachexia. c. Restore stores of glycogen in the liver. d. Treat the adverse effect of diarrhea.
C
What are the only drugs currently used to treat type 2 DM during pregnancy and lactation? (Select all that apply.) a. Acarbose (Precose) b. Glipizide (Glucotrol) c. Insulin d. Metformin (Glucophage) e. Pioglitazone (Actos)
C,D
A patient is admitted in a state of diabetic ketoacidosis. The resident orders insulin Lispro 0.1 mg/ kg/hr to be administered by intravenous (IV) drip. What should the nurse do? a. Calculate the insulin dose and mix it with 100 mL of normal saline. b. Calculate the insulin dose and mix it with 100 mL of D5 W. c. Calculate the insulin dose and infuse the solution prepared by the pharmacy. d. Consult the prescriber STAT.
D
A patient is prescribed 4 units of insulin aspart (NovoLog) based on a sliding scale relating to SMBG. Available syringes are marked 50 units in 0.5 mL or 100 units in 1 mL. Why should the nurse choose the 50 units in a 0.5-mL syringe to administer this dose? a. It is the only syringe that can accurately measure this dose. b. It is the only syringe that has the correct needle for administering this dose. c. It is easier to administer the insulin using this syringe. d. It is easier to see the line indicating the 4 units on this syringe.
D
Research suggests that intensive insulin therapy (tight control) in type 1 and 2 DM is most effective in preventing a. cerebral vascular accidents (CVAs). b. neuropathic pain. c. peripheral vascular disease requiring amputation. d. visual damage.
D
The nurse is caring for a 62-year-old patient who has had type 2 DM for 15 years. She is prescribed Humulin N 25 units in the morning. Recently, the patient has experienced several hypoglycemic episodes despite maintaining her usual medication, diet, and exercise regimen. The patient's lab studies include C-peptide 1 ng/mL (normal 5 to 12 ng/ mL). It would be most important for the nurse to assess the patient's a. calibration of her glucose meter. b. intake of carbohydrates. c. intake of water. d. sight for administering the proper amount of insulin.
D
The nurse is preparing to perform the first assessment of the 3- to 11-shift at 3:30 pm (1530). Several assigned patients have diabetes. The patient receiving which drug should be assessed for hypoglycemia first? a. Acarbose (Precose) 50 mg 3 times a day with meals b. Glargine (Lispro) insulin units every evening plus insulin aspart (NovoLog) according to dietary intake and SMBG c. Metformin (Glucophage) 500 mg before breakfast and supper d. Neutral protamine Hagedorn (NPH) (Humulin N) 35 units every morning
D
Which nursing outcome would be most appropriate for a patient who is prescribed acarbose (Precose) or nateglinide (Starlix)? a. Bedtime SMBG 160 mg/dL b. Fasting blood glucose less than 90 mg/dL c. Glycosylated hemoglobin (A1c) 7% d. Two-hour postprandial blood sugar less than 150 mg/dL
D
Which type of diabetes often exists for years before diagnosis, but fasting blood glucose is not elevated because of hyperinsulinemia? a. Gestational diabetes b. Juvenile diabetes c. Type 1 diabetes d. Type 2 diabetes
D
T/F: Blood sugar control will best be achieved if the patient follows a plan created by the health care providers.
F
T/F: Clear insulin is always short-acting.
F
T/F: Once the patient's blood sugar is stabilized, the patient will be able to maintain control with oral drugs.
F
T/F: Treatment can be monitored by blood or urine.
F
T/F: Weight loss is always needed to decrease the patient's insulin requirements.
F
T/F: Administering insulin or sulfonylurea drugs and not eating can cause serious effects from the blood sugar going too low.
T
T/F: Diabetes affects blood flow to all organs.
T
T/F: Exercise improves cellular response to insulin.
T
T/F: Foods with a low glycemic index have fewer carbohydrates than those with a high glycemic index.
T
T/F: Glycemic control involves metabolism of carbohydrates, proteins, and fats.
T
T/F: Insulin therapy with one long-acting agent that mimics the body's basal insulin secretion and another short-acting agent to cover eating most closely mimics normal functioning.
T
T/F: Saturated fats should be limited to less than 10% of the total calories.
T
T/F: Tight glucose control decreases the incidence of kidney failure.
T
A diabetic patient who receives glipizide and miglitol (Glyset) is diaphoretic, tachycardic, and anxious. The SMBG is 43 mg/dL. What product would be most effective to quickly raise the patient's blood sugar? a. Glucose tablet b. Honey c. Orange juice d. Sugar cube
A
A nurse administered 30 units of glargine (Lantus) insulin in the same syringe as 8 units of aspart (Humalog) insulin coverage so that the patient would be "pinched" by only one injection. The nurse contacts the prescriber and monitors the patient for which symptom caused by how this combination changes the absorption of the insulin? a. Profuse sweating b. Itching c. Thirst d. Vomiting
A
A patient has been prescribed 5 units of insulin aspart (NovoLog) and 25 units of insulin detemir (Levemir) to be administered at 0800. What should the nurse do? a. Draw up the two insulins in different syringes. b. Draw up 5 units of aspart first, then 25 units of detemir insulin in the same syringe. c. Draw up the clear insulin, then the cloudy insulin, in the same syringe. d. Inject the insulins in a different subcutaneous site (abdomen versus arm versus thigh) than the previous morning.
A
A type 2 DM patient who is prescribed tolbutamide (Orinase) has just been prescribed carvedilol (Coreg). Which statement suggests that the patient needs additional teaching? a. "I should check my SMBG before meals and bedtime and any time I don't feel right." b. "I should eat less because this drug will make my blood glucose go up." c. "I should not assume that my blood sugar is OK if I don't feel the palpitations that I usually get when my SMBG is low." d. "I should take my pulse before taking the carvedilol and consult my doctor if it is less than 60 beats/min."
A
After teaching about the drug glipizide (Glucotrol), which statement, if made by the patient, would suggest that the patient understood the teaching? a. "I need to notify my doctor if I have episodes of sweating and shakiness." b. "I should not have low blood sugar with this drug because it does not stimulate the release of insulin." c. "It is all right to eat what I want as long as I take enough of the drug." d. "This drug is less potent than the newer drugs."
A
When obtaining a new vial of NPH insulin from refrigeration, the nurse notes that the suspension is partially frozen. What should the nurse do? a. Discard the vial and obtain a new one from the pharmacy. b. Shake the vial vigorously to produce heat. c. Warm the suspension in warm water. d. Withdraw the unfrozen portion then discard the rest.
A
Which antihypertensive drug might be prescribed for a patient with DM who does not have the diagnosis of hypertension? a. Benazepril (Lotensin) b. Carvedilol (Coreg) c. Diltiazem (Cardizem) d. Furosemide (Lasix)
A
Which nursing action is appropriate when a patient is prescribed bromocriptine (Cycloset) for type 2 DM? a. Change positions slowly. b. Elevate the head of the bed for 30 minutes after eating. c. Monitor fluid intake and output. d. Weigh daily.
A
A diabetic patient who has been using traditional insulin therapy has been prescribed intensive insulin therapy to achieve tighter glucose control. Which information should be included in the teaching? a. An insulin pump is used to provide the best glucose control and requires about the same amount of attention as intensive insulin therapy. b. Intensive insulin therapy usually requires four injections of a rapid-acting insulin each day in addition to an injection of a basal insulin. c. Intensive insulin therapy is indicated only for newly diagnosed type 1 diabetics who have never experienced ketoacidosis. d. Studies have shown that intensive insulin therapy is most effective in preventing the macrovascular complications characteristic of type 2 DM.
B
What would be the most appropriate nursing intervention for a 23-year-old patient who, for the first time, has a fasting plasma glucose level of 145 mg/ dL? a. Advise the patient to include 30 minutes of vigorous exercise in his daily activities. b. Discuss possible diet changes with the patient. c. Explain the need for oral antidiabetic medication to the patient. d. Teach the patient how to do a urine dip for glucose and ketones.
B
The nurse is preparing to administer the morning dose of 150 units of regular insulin. Available is regular insulin 500 units/mL (U-500). The facility has only 100 units/mL (U-100) syringes available. The nurse would draw the U-500 insulin up to what line on the U-100 syringe?
30 units line. U-500 insulin is 5x stronger than U-100 insulin, so 20% of the # of units should be given