PNE 104. Ch. 42 - Antidiabetic Drugs. Clinical Pharmacology. Susan Ford 11th. ED.
When learning about type 1 diabetes, what would the student nurses learn is a distinguishing characteristic of this disease?
Exogenous insulin is required for life.
In what condition is human insulin not recommended for diabetic patients?
Type 2 diabetes controlled by diet
A nurse at a health care facility is caring for a patient who has been prescribed insulin for the first time. Which preadministration assessment should be performed by the nurse before the first dose of insulin is given?
General assessment of the skin
The nurse is caring for a postoperative client whose diabetes has been well controlled on acarbose. The client is not allowed to take anything orally following complications of abdominal surgery and is receiving high-glucose total parenteral nutrition via a central IV line. What medication can the nurse administer intravenously to control the client's blood glucose level?
regular insulin Rationale: Only regular insulin can be administered IV. No other insulins or oral antidiabetic medications can be given IV.
The brother of a client who uses insulin for management of type 1 diabetes will be prefilling the client's insulin syringes. The nurse knows that these prefilled syringes may be kept in the refrigerator for how long?
one week
Increased urination is termed ____________.
polyuria
When considering the management of diabetic ketoacidosis (DKA), what type of insulin can be administered intravenously?
regular Rationale: Regular insulin (insulin injection) has a rapid onset of action and can be given intravenously. Therefore, it is the insulin of choice during acute situations, such as DKA, severe infection or other illness, and surgical procedures. All the other options are administered subcutaneously.
A client is prescribed sitagliptin. The nurse would expect to administer this drug by which route?
Oral Rationale: Sitagliptin is administered orally.
A nurse is providing patient education to a 13-year-old girl who was just diagnosed with type 1 diabetes mellitus. Which statement by the patient will alert the nurse that special instructions regarding insulin are necessary?
"I am on the middle school track team."
The nurse is reinforcing teaching about acarbose (Precose) to a client with newly diagnosed type 2 diabetes. Which statement by the client indicates a need for further understanding?
"I must take this medication one hour before I eat."
A young man has been diagnosed with type 2 diabetes and has been prescribed glyburide. Which of the following statements suggests that the nurse should perform further health education?
"I'll plan to take my glyburide each night before I go to bed."
A client newly diagnosed with type 2 diabetes has attended educational sessions to provide insight into the diagnosis. Which of the client's statements should prompt the nurse to provide further teaching?
"I'm disappointed, but I take some solace in the fact that I won't ever have to have insulin injections." Rationale: Among people with type 2 diabetes, 20% to 30% require exogenous insulin at some point in their lives. Obesity is a major cause, and vigilant treatment can prevent future sequelae. The essence of type 2 diabetes is the pancreas' inability to meet insulin needs.
The nurse has just completed discharge instructions to a client who will be using a pen device to deliver his insulin dose. What statement by the client indicates a need for further instruction?
"If I forget to take my insulin pen, I will be able to use the one that my wife uses."
During a teaching session on the care of the diabetic patient, a family member asks why her daughter has a different insulin than her best friend. The nurse should make which statement to explain the differences in insulin?
"Insulins have different onsets and durations of action."
A 59-year-old man with type 2 diabetes is prescribed metformin. When the patient returns to the clinic, he reports that he has lost 8 pounds in a month. How should the nurse respond?
"Please continue taking the medication and monitoring your weight. This is an expected outcome of this drug therapy."
The nurse assesses a patient's blood glucose level after administering insulin. Which result would the nurse interpret as indicative of severe hypoglycemia?
34 mg/dL
Insulin analogs are synthesized in the laboratory by altering the type or sequence of amino acids in insulin molecules. Which of the following insulin analogs is a short-acting product? Insulin lispro Insulin aspart Insulin glulisine All the above
All the above Insulin lispro Insulin aspart Insulin glulisine Rationale: Insulin lispro (Humalog), insulin aspart (NovoLog), and insulin glulisine (Apidra) are all short-acting (or "rapid-acting") products. They have a rapid onset and a short duration of action.
A patient is to be administered glipizide (Glucotrol). Which factor would prohibit the administration of glipizide (Glucotrol) to this patient?
Allergy to sulfonamides
The nurse's assessment of a patient who has presented to the emergency department reveals hyperglycemia. Which type of insulin will have the most rapid effect on the patient's blood sugar levels?
Aspart
A nurse is caring for a patient receiving metformin drug therapy to improve glycemic control. What adverse reaction to the drug should the nurse monitor the patient for?
Asthenia
Chapter 42 Review: Prepare for NCLEX: Build your knowledge #4 Which of the following would be the correct method of administering insulin glargine?
At bedtime
Lipodystrophy
Atrophy (wasting away) of subcutaneous fat. Appears as slight dimpling or pitting.
A patient 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
Glycosylated Hemoglobin (HbA1c)
Blood test that monitors average blood glucose level for a 3-to-4-month period; Is a test in response to treatment; measures last 3 months/6 weeks of glucose in the RBCs. Levels between 6.5% and 7% indicate good control of diabetes. Results of 10% or greater indicate poor blood glucose control for the last several months.
Diabetes Mellitus
Complicated, chronic disorder; Disease in which insulin does not help glucose enter the cell.
The nurse teaches the male client with type 1 diabetes that insulin needs vary depending upon certain conditions. The client requires additional teaching when he learns that his insulin needs may increase because of what condition? (Select all that apply.)
Decreased food intake Exercise
A patient with a recent diagnosis of type 2 diabetes has begun taking metformin. This drug will help the patient achieve adequate blood sugar control through which of the following mechanisms? (Select all that apply)
Decreasing glucose production by the liver Improving insulin sensitivity Decreasing glucose absorption in the GI tract
A patient with type 1 diabetes has been admitted to the hospital for orthopedic surgery and the care team anticipates some disruptions to the patient's blood glucose levels in the days following surgery. Which of the following insulin regimens is most likely to achieve adequate glycemic control?
Doses of basal insulin twice daily with regular insulin before each meal
Polyphagia
Eating large amount of food
Insulin binds with and activates receptors on cell membranes. Once insulin-receptor binding occurs, the membranes become highly permeable to glucose. Which action does this enable?
Entry of glucose into the cells Rationale: After insulin-receptor binding occurs, cell membranes become highly permeable to glucose and allow rapid entry of glucose into the cells.
Polydipsia
Excessive thirst
T/F: An athlete eats a high-protein meal. The breakdown of protein by insulin will yield an increased production of glycerol. True or false?
False
T/F: Patients with type 2 diabetes have nonfunctioning beta pancreatic cells.
False
T/F: The average adult pancreas secretes less than 30 units of insulin daily. True or false?
False
The nurse is providing education to a client who has been prescribed therapy with an antidiabetic medication. During teaching, the nurse will caution the client against heavy intake of which herb?
Garlic Rationale: Garlic has been known to cause hypoglycemia when taken with antidiabetic medications. Anise, basil, and oregano are not noted to carry this risk.
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.)
Glimepiride Glyburide
Which is the best indicator of overall diabetic control?
Glycosylated hemoglobin levels
The nurse is interviewing a client who was diagnosed with type 2 diabetes about four months ago. The client never records glucometer readings but says that everything is just fine. What laboratory test does the nurse anticipate the health care provider will order for this client?
HbA1c
Which of the following insulin is always clear? (Choose one)
Humulin R
The physician 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 patient?
Hypoglycemia
During insulin teaching, when should the nurse advise the patient to administer insulin aspart (Apidra)? (Choose one)
Immediately before a meal
A patient is receiving acarbose. What would the nurse incorporate into the teaching plan for this patient about the action of the drug?
Inhibits an enzyme to delay glucose absorption
Which is an example of long acting insulin?
Insulin glargine (Lantus)
A nurse is presenting an educational event at a local senior citizens' club about diabetes. What would the nurse tell the attendees at the event about diabetes?
It is a complicated disorder that alters the metabolism of glucose. Rationale: Diabetes is a complicated disorder that alters the metabolism of glucose, fats, and proteins affecting many end organs and causing numerous clinical complications. It is part of the metabolic syndrome, a collection of conditions that predispose to cardiovascular disease.
Which would be appropriate to include in teaching a client with type 2 diabetes?
It is possible with weight loss and exercise to discontinue the use of antidiabetic medication.
As a diabetic educator, the nurse is teaching a newly diagnosed diabetic about aspects of the disease process. What would the nurse tell the patient about the body's control of glucose?
It is related to fat and protein metabolism
The two major classifications of diabetes are type 1 and type 2. What is a distinguishing characteristic of type 1 diabetes?
Lifelong exogenous insulin is required. Rationale: Type 1 diabetes results from an autoimmune disorder that destroys pancreatic beta cells. Insulin is the only effective treatment for type 1 diabetes, because pancreatic beta cells are unable to secrete endogenous insulin and metabolism is severely impaired. Insulin cannot be given orally, because it is destroyed by proteolytic enzymes in the GI tract. Although the onset of type 1 diabetes frequently occurs in childhood, it can also occur in adulthood.
Hypoglycemia
Low blood glucose(sugar) level. Too much insulin; blood glucose level equals < 60 mg/dL. ***Patients require sugar.
A client who has been prescribed metformin is scheduled to undergo diagnostic testing with the administration of parenteral radiographic contrast media containing iodine. What fact should direct the nurse's plan of care for this client?
Metformin should be discontinued at least 48 hours before and after diagnostic tests that use contrast medias. Rationale: Metformin should be discontinued at least 48 hours before diagnostic tests are performed with contrast media and should not be resumed for at least 48 hours after the tests are done and tests indicate renal function is normal. None of the other options are required.
A patient is prescribed sitagliptin. The nurse would expect to administer this drug by which route?
Oral
Sulfonylureas
Oral diabetes medications: 1. Glyburide 2. Glipizide 3. Glimepiride Action Site: Pancreas Action: More insulin release from pancreas Side Effects: Low blood sugar, weight gain (increase appetite), nausea/vomiting Considerations: Some given on empty stomach - some with food. Look up drug for timing. Contraindications: Patients with known hypersensitivity to the drugs, DKA, severe infection or severe endocrine disease. Interactions: Beta blockers mask low blood sugar symptoms. Glyburide & Cipro: Severe low blood sugar
Chapter 42 Review: Prepare for NCLEX: Apply your knowledge #6 A client with diabetes received a glycosylated hemoglobin test result of 10%. This indicates _________.
Poor blood glucose control. Levels between 6.5% and 7% indicate good control of diabetes. Results of 10% or greater indicate poor blood glucose control for the last several months.
The physician prescribes glyburide for Tim, a newly diagnosed type 2 diabetic. The nurse knows that this medication acts by which mechanism?
Produces hypoglycemia by increasing insulin secretion from the pancreas
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:
Regular
A student asks the nursing instructor what insulin has the quickest therapeutic effect once administered. What would be the best response?
Regular (Humulin R) Rationale: Regular insulin has the quickest onset of 30-60 minutes. PZI and ultralente have an onset of 4-8 hours. NPH has an onset of 60-90 minutes.
Chapter 42 Review: Prepare for NCLEX: Build your knowledge #2 Which of the following medications may be used for both type 1 and 2 diabetes?
Regular Insulin
A patient is admitted to the Emergency Department in diabetic ketoacidosis (DKA) with a blood glucose level of 33 mmol/L. The physician orders an initial dose of 25 U insulin IV. Which type of insulin will be administered?
Regular insulin
A patient is admitted to the emergency department in diabetic ketoacidosis (DKA). The physician orders an initial dose of 25 units insulin IV. Which type of insulin will be administered?
Regular insulin
Chapter 42 Review: Prepare for NCLEX: Apply your knowledge #7 The mental health center is writing new admission protocols. Which client population should be routinely tested for elevated blood sugars?
Schizophrenic clients on second-generation antipsychotics
A nurse is working with a newly diagnosed diabetic patient on understanding hypoglycemia and insulin reactions. Which action would be most important for the patient to understand when planning the response to an insulin reaction?
Take an oral dose of some form of glucose as soon as possible.
A client calls the clinic and tells the nurse that his new medication, glyburide (a sulfonylurea), is causing a lot of nausea. What does the nurse expect the health care provider to order for this client?
Take half the dose twice a day.
What main difference between alpha-glucosidase inhibitors, such as acarbose and miglitol, and insulin or metformin therapy would the nurse include during patient education?
They inhibit the absorption of regular cane sugar.
As the first line treatment, a patient with type 2 diabetes has diet and exercise. When these fail, what may be added as monotherapy or in combination with metformin to control their disease process?
Thiazolidinediones
Chapter 42 Review: Prepare for NCLEX: Build your knowledge #5 Which of the following symptoms would alert the nurse to a possible hyperglycemic reaction?
Thirst, abdominal pain, nausea
T/F: Glycosylated hemoglobin levels provide reliable evidence of blood glucose control.
True
Insulin Pump
Uses only "Regular Insulin." A delivery system which attempts to mimic the body's normal pancreatic function, is battery powered. Needle change is required every 1 to 3 days.
When blood glucose levels are high, glucose molecules attach to ____________ in the red blood cells.
hemoglobin
A nurse is preparing to administer an insulin that is clear. Which insulin would the nurse most likely administer?
humulin R Rationale: Regular insulin (Humulin R) is clear, whereas intermediate-acting (Humulin N and Humulin L) and long-acting (Humulin U) insulins are cloudy.
Diabetic _________ is a potentially life-threatening deficiency of insulin.
ketoacidosis
Symptoms of Lactic Acidosis:
- Unexplained hyperventilation - Myalgia (muscle pain) - Malaise (body weakness or discomfort) - GI symptoms - Unusual somnolence (sleepiness, drowsiness) ***Patients taking Metformin are at risk.
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 assists glucose molecules to enter the cells of muscle and fat tissues." Rationale: 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.
What instructions would be important to give to a 50-year-old client with type 2 diabetes who has been switched from glyburide (DiaBeta), a sulfonylurea, to repaglinide, a meglitinide?
"It stimulates insulin production, so you need to eat soon after taking the medication."
What instructions would be important to give to a 50-year-old client with type 2 diabetes who has been switched from glyburide , a sulfonylurea, to repaglinide, a meglitinide?
"It stimulates insulin production, so you need to eat soon after taking the medication." Rationale: Glyburide's onset of action is 2 to 4 hours, and its duration is 24 hours. Repaglinide's onset of action is within 30 minutes, peak is 1 hour, and duration is approximately 3 to 4 hours. Repaglinide is taken 15 to 30 minutes before each meal because it stimulates the pancreas to secrete insulin to correspond to the food intake. If there is no food intake, the person is at risk of hypoglycemia. Glyburide, a sulfonylurea, also stimulates pancreatic cells, but not until 2 to 4 hours after it is taken. Repaglinide is not less potent, it is not more potent, and the two medications are not virtually the same.
A 59-year-old man with type 2 diabetes is prescribed metformin. When the client returns to the clinic, he reports that he has lost 8 pounds in a month. How should the nurse respond?
"Please continue taking the medication and monitoring your weight. This is an expected outcome of this drug therapy." Rationale: The nurse should advise the client to continue therapy as prescribed because weight loss is a beneficial adverse effect for type 2 diabetics. The client need not seek a decrease in dosage or change in medication, nor would discontinuation of the drug be warranted.
A client has been newly diagnosed with type 2 diabetes. What statement would be appropriate for the nurse to include in the teaching?
"Regular exercise makes your body better able to use the insulin it produces." Rationale: Exercise is an extremely strong hypoglycemic agent, so the nurse should encourage the practice. Diabetics need to check their blood sugar level regardless of whether they are prescribed insulin. The need for insulin injections is determined by the function of the pancreas and its ability to produce sufficient quantities of insulin. It is not correct to assume diet is the only factor in this process. Alcohol should be avoided, and the dosage of oral antidiabetic medication should not be altered without guidance from a health care provider.
A patient asks the nurse why a quick-acting sugar given by mouth is better in the regulation of insulin than the use of intravenous glucose for a low blood sugar. Which of the following statements by the nurse represents the most appropriate response to this question?
"The ingestion of food allows the digestive tract to stimulate vagal activity and the release of incretins." Rationale: Oral glucose is more effective than intravenous glucose because glucose or food in the digestive tract stimulates vagal activity and induces the release of gastrointestinal hormones called incretins. The combination of insulin and food does not yield a higher blood glucose than intravenous insulin. Food stimulates the vagal nerve activity, but intravenous glucose does not. A statement that indicates that the patient is mistaken will belittle the patient and should be rephrased.
Causes of Hypoglycemia:
- Eating too little - Too much insulin given - Increase in physical activity
Symptoms of Hyperglycemia:
- Elevated glucose levels (over 200 mg/mL) - Headache - Increased thirst - Epigastric pain - Nausea - Vomiting - Hot, dry flushed skin - Restlessness - Diaphoresis (sweating)
S/S of Hypoglycemia:
- Fatigue - Lethargy (lack of energy) - Headache - Hunger - Nausea - Pale/moist skin - Confusion - Diaphoretic (sweating) - Shakiness - Unsteady
S/S of Type I:
- Hyperglycemia (Too little insulin; High blood glucose(sugar) level) - Polyuria (urine) - Polydipsia (thirst) - Polyphasia (hunger) - Weight Loss
Mgmt. of Hypoglycemia:
- Yogurt, juice (cranberry) - NPO if unconsciousness (sugar packet under tongue)
The female client is scheduled to get her breakfast tray at 0700. At what time should she receive her prescribed dose of NPH insulin?
0630 (6:30 am) Rationale: The dose of medication is based on blood sugar level and must be determined by the health care provider. NPH insulin is injected under the skin 15 or 30 minutes before meals and/or a bedtime snack.
Chapter 42 Review: Prepare for NCLEX: Alternate-Format Questions #10 A client is prescribed 40 units NPH insulin mixed w/5 units of regular insulin. 1. What is the total insulin dosage? 2. Describe how you would prepare the insulins.
1. 45 units 2. Inject air into NPH vial, inject air into regular vial, draw out 5 units of reg. insulin, then draw out 40 units of NPH.
Chapter 42 Review: Prepare for NCLEX: Alternate-Format Questions #9 A client is prescribed Metformin (Glucophage) 1000 mg orally BID. The drug is available in 500-mg tablets. The nurse administers _________. What is the total daily dosage of Metformin?
2 tablets per dose; total daily dose = 2000 mg.
A diabetic patient has been admitted to the ICU with diabetic ketoacidosis (DKA). What is the first step in the treatment of this patient?
Administration of IV fluids
Which strategy will NOT increase the therapeutic effect of insulin?
All insulin should be stored in a refrigerator but never frozen.
The nurse is caring for a client who has been prescribed glyburide. Which factor, if identified in the client history, would cause the nurse to inform the health care provider of a contraindication to use?
Allergy to sulfonamides Rationale: 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 glyburide.
An older adult client has been prescribed metformin for the treatment of type 2 diabetes for several years. Which change in the client's laboratory values may demonstrate a need to discontinue the medication?
An increase in serum lactate. Rationale: It is essential to discontinue metformin if renal impairment occurs or if serum lactate increases. The other listed changes in laboratory values do not necessarily indicate that metformin should be discontinued.
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.)
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.
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?
Blurred vision
A diabetic patient has just received an insulin pump. What would be important to include in patient teaching?
Check blood glucose frequently.
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?
Check the dosage with another nurse. Rationale: 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.
Symptoms of DKA (diabetic ketoacidosis)
Classified as blood glucose levels > than 500 mg/dL - Rapid, deep breathing - Vomiting, abdominal pain - Excess urination - Rapid, weak pulse - Thirsty - Acetone breath (nail polish remover, juicy fruit)
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
The nurse is caring for a client who takes miglitol (Glyset) for type 2 diabetes. The client reports feeling slightly confused and the stat glucometer reading is 56 mg/dL. What should the nurse provide for this client to increase the blood glucose?
Commercial glucose tablets
Insulin
Define: Is a hormone produced by the pancreas that regulates how glucose gets into cells and is used for energy. Actions: Promotes protein synthesis; Is essential for cells to use glucose for energy and for proper metabolism of protein and fat in our bodies.
Glucometer
Device to monitor blood glucose level
Type II (NIDDM)
Diagnosis where the patient develops a decreased production of insulin; cells develop a resistance to insulin, making it more difficult for glucose to enter the cell. Non-insulin dependent. Usually occurs after age 40, 90 - 95% of diabetic population. Mgmt: Weight control, diet, oral hypoglycemic drugs
Ms. Newton, a newly diagnosed diabetic, is prescribed glyburide. As the nurse providing instruction, you identify which occurrence as a classic symptom of hyperglycemia?
Excessive urination
Which is a non-insulin injectable antidiabetic drug?
Exenatide (Byetta)
Which insulin would the nurse need to administer as a separate injection if the order also included NPH insulin?
Glargine Rationale: Insulin glargine cannot be mixed in solution with any other insulin.
A patient is brought to the Emergency Department (ED) with severe hypoglycemia. What drug would the nurse prepare to administer intravenously?
Glucagon (GlucaGen)
A nurse should advise patient, especially elderly patients, to eat within 30 minutes of the administration of which of the following antidiabetic drugs to prevent hypoglycemia?
Glyburide
A diabetic patient is taking regular and NPH insulin to manage his diabetes. What is the best evaluation tool to measure the overall patient response to the insulin therapy?
Glycosylated hemoglobin (HbAlc) levels
The nurse is preparing to administer 20 units of NPH insulin to a client. Before administering the medication, the nurse should implement which intervention?
Have a colleague confirm the dosage. Rationale: Before administering insulin, client safety requires that two nurses always check the dosage. Assessing the client's understanding of the disease may or may not be appropriate or necessary at this time. Injection sites are not massaged before administration. It is not necessary to assess urine for the presence of glucose.
Hyperglycemia
High blood glucose(sugar) level. Too little insulin; blood glucose level equals > 200 mg/dL ***Treated with insulin to bring sugar down
A hospital patient's medication administration record specifies a dose of NPH insulin to be administered subcutaneously at 8 AM. The nurse has checked the patient's blood glucose level prior to administering the drug and it is 55 mg/dl. How should the nurse respond to this assessment finding?
Hold the dose of insulin and consult with the client's primary care provider. Rationale: When a patient's blood glucose is below 70 mg/dl, it is necessary to use caution when administering insulin. Usually the dose is held until blood sugars rise above this level and the provider consulted. Glucagon is unnecessary at this blood sugar level.
Glucagon
Hormone secreted by the alpha cells of the pancreas that increases the concentration of glucose in the blood
Polyuria
Increased urination
Storage of Insulin:
Insulin is kept at room temperature away from heat and direct sunlight if used within 1 month (and up to 3 months if refrigerated).
Regular Insulin
Is the only insulin that may be given "Intravenously" (IV) during emergency situations. EX. DKA (diabetic coma), or used for insulin pump.
A patient has been prescribed acarbose (Precose). What is the advantage of acarbose?
It delays the digestion of complex carbohydrates.
What is the expected action of sitagliptin on type 2 diabetes?
It slows the rate of inactivation of the incretin hormones. Rationale: Sitagliptin minimizes the rate of inactivation of the incretin hormones to increase hormone levels and prolong their activity. Sitagliptin does not block the S phase of the cell cycle. Sitagliptin is not a synthetically prepared monosodium salt nor does it inhibit hydrogen, potassium, and ATPase.
The nurse admits a client who has been diagnosed with diabetic ketoacidosis, and will look for what assessment findings consistent with this diagnosis? (Select all that apply.)
Ketones in the urine Flushed, dry skin
The nurse admits a client with type 2 diabetes who takes metformin (Glucophage), and indicates that the client has a nursing diagnosis of ineffective breathing pattern. What complication of the client's current drug therapy does the nurse believe the client is experiencing?
Lactic acidosis
Which of the following represent the American Diabetes Association recommended HbA1c goal?
Less than 7%
Diabetic Ketoacidosis (DKA)
Life-threatening deficiency of insulin resulting in "severe hyperglycemia" and excessively high levels of ketones in the blood. Classified as blood glucose levels > than 500 mg/dL. ***Even when protocol is in use, you should immediately notify the primary health care provider if the blood glucose level is greater than 400 mg/dL.
The nurse is preparing to administer insulin lispro (Humalog) to a client at 7 AM. What is the nurse's top priority intervention related to this medication?
Make sure the client's breakfast is available in the next 5-10 minutes
After teaching a class about the various drugs used to control blood glucose, the instructor determines that the teaching was successful when the class identifies what as a biguanide?
Metformin Rationale: Metformin is classified as a biguanide. Miglitol is an alpha-glucosidase inhibitor. Tolbutamide is a first generation sulfonylurea. Glipizide is a second generation sulfonylurea.
The nurse is caring for a client, age 77 years, who has type 2 diabetes and chronic kidney disease. Which drugs will be used with great caution in this client? (Select all that apply.)
Metformin (Glucophage) Exenatide (Byetta) Miglitol (Glyset)
Your client is scheduled to undergo diagnostic testing with the administration of parenteral radiographic contrast media containing iodine. Since your client is taking metformin, you know that
Metformin should be discontinued at least 48 hours before and after diagnostic tests.
The nurse is caring for a client who is on insulin therapy. The client may need to increase the insulin dose if he is also required to take which drug? Select all that apply.
Morphine sulfate Furosemide Nicotine (via cigarettes
Rapid Acting Insulin
Names: 1. Humalog (Lispro) 2. Novolog (Aspart) 3. Apidra (Glulisine) Onset: (When meds begin to work): 15 - 30 min. Peak: (When meds are @ MAX therapeutic level): 30 - 90 min. Duration: (how long meds stay in the bloodstream): 3 - 4 hrs.
Intermediate Acting Insulin
Names: Novolin NPH Onset: (When meds begin to work): 1.5 - 4 hrs. Peak: (When meds are @ MAX therapeutic level): 4 - 12 hrs. Duration: (how long meds stay in the bloodstream): up to 24 hrs.
Short Acting Insulin
Names: Novolin Regular Onset: (When meds begin to work): 30 - 60 min. Peak: (When meds are @ MAX therapeutic level): 2 - 3 hours Duration: (how long meds stay in the bloodstream): 3 - 6 hrs.
Biguanides
Oral diabetes medication: Glucophage (Metformin) Action Site: Liver; sensitizes the liver to circulating insulin levels and reduces hepatic glucose production Action: Less liver glucose production Side Effects: Abdominal fullness; gas diarrhea, weight loss (suppresses appetite). Considerations: Take with meal Contraindications: Patients with heart failure (HF), renal disease, acute or chronic acute or chronic metabolic acidosis, including ketoacidosis. Patients older than 80 and during pregnancy. Interactions: Contrast iodine dye can lead to acute renal failure. ***Hold 48 hours before iodine test (MRI, CT scan). Alcohol raises risk of lactic acidosis. ***Watch BUN & creatinine levels when patient is on this medication. Metformin is combined with several other drugs.
Chapter 42 Review: Prepare for NCLEX: Build your knowledge #3 Which of the following would the nurse most likely choose to treat a hypoglycemic reaction?
Orange Juice
Chapter 42 Review: Prepare for NCLEX: Build your knowledge #1 Where is insulin produced in the body?
Pancreas
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?
Perform a blood sugar analysis. Rationale: 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.
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?
Place glucose gel between the gums and cheek.
The nurse is assisting a client in learning insulin self-injection technique. Which way is most helpful for the client to understand how to rotate injection sites?
Provide the client with a manufacturer's template for site rotation.
A patient is in diabetic ketoacidosis. The patient blood glucose level is over 600. The physician has ordered the patient to receive an initial dose of 25 units of insulin. What type of insulin will be administered intravenously?
Regular insulin
A client is admitted to the emergency department in diabetic ketoacidosis (DKA). The physician orders an initial dose of 25 units insulin IV. Which type of insulin will be administered?
Regular insulin Rationale: Because regular insulin has a rapid onset of action and can be given IV, it is the insulin of choice during acute situations, such as DKA, severe infection or other illness, and surgical procedures. NPH is an intermediate-acting insulin; detemir and insulin glargine are long-acting products.
Type I (IDDM)
Where the pancreas does not produce Insulin. Early onset. Mgmt: Patients require insulin to survive
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 Rationale: Subcutaneous injection currently is the most common method for administering insulin.
A client has not had anything to eat or drink within the past 12 hours and has a fasting blood glucose level of 125 mg/dL. What does the nurse interpret these findings to indicate?
The client has an impaired fasting blood glucose level. Rationale: The client has fasting blood glucose level between 100 and 125 mg/dL, which indicates impaired fasting glucose (IFG), or prediabetes. The glucose level under 100 mg/dL would be a normal fasting blood glucose level. There is insufficient testing to indicate that the client has diabetes mellitus type 1 and further testing is required. The 12-hour fasting window would negate the effects on the prior day's meals.
Which condition must be met in order for glyburide treatment to be effective?
The client must have functioning pancreatic beta cells. Rationale: Because glyburide stimulates pancreatic beta cells to produce more insulin, it is effective only when functioning pancreatic beta cells are present. The presence of normal blood glucose levels would render the medication unnecessary. Self-administration is common but not absolutely necessary.
James, age 35, begins the administration of glyburide for treatment of diabetes mellitus type 2. As the nurse caring for John, you instruct him about the medication. Which statement would NOT be appropriate advice for James?
The medication can be taken at dinner time.
Glycosylated hemoglobin measures average blood glucose over what time period?
The past 3 or 4 months
Oral Antidiabetic Drugs
These drugs are only used for Type II diabetes
The nurse is caring for a client who wears an insulin pump for control of his type 1 diabetes. The health care provider has written an order for supplemental regular insulin. The nurse knows this insulin was ordered for what reason?
To cover any episodes of hyperglycemia that occur while in the hospital. Rationale: Regular insulin is given subcutaneously to clients who have insulin pumps to "cover" any episodes of hyperglycemia that occur. The client continues to use the insulin pump and follows the same diet as at home. The supplemental insulin will decrease blood sugar and therefore will not prevent hypoglycemia.
T/F: A 4-year-old child with type 1 diabetes mellitus becomes angry and then lethargic. The parent should be taught that a change in behavior may indicate hypoglycemia. True or false?
True
The nurse instructs a client who has been prescribed extended-release metformin (Glucophage XR) to take the medication at what time?
With evening meal
A home care nurse is caring for several clients with diabetes. The nurse's role in caring for these clients includes:
all the above tasks.
Pramlintide is administered orally.
false subcutanious
When teaching a client how to use a glucometer, the nurse should emphasize that the most accurate testing site when blood glucose is rapidly changing or hypoglycemia is suspected is in which area?
finger Rationale: The nurse teaching a client to use a glucometer should emphasize that the most accurate testing site when blood glucose is rapidly changing or hypoglycemia is suspected is the finger. Insulin is rotated gently in the palms of the hand to mix not a place to obtain a sample. Insulin can be injected into the thighs as a site of administration not a site for blood sampling. The forearm is not an appropriate site.
An elevated blood glucose or sugar level is termed ________.
hyperglycemia
The nurse educator works at the diabetes clinic. When talking to a class of adolescent diabetics, the educator tells the students that the most recognized signs of diabetes are:
hyperglycemia and glycosuria.
When reviewing the medication list of a client being seen in the clinic, the nurse notes that the client is receiving glipizide. Based on the nurse's understanding, this drug is used to treat:
hyperglycemia. Rationale: Glipizide is an antidiabetic agent with the desired action of lowering the blood glucose level. It is used to treat hyperglycemia. It would worsen, not treat, hypoglycemia, and it has no role in treating abnormal potassium levels (hypokalemia or hyperkalemia).
The health care provider prescribes glyburide for a client who is a newly diagnosed type 2 diabetic. The nurse knows that this medication produces hypoglycemia by:
increasing insulin secretion from the pancreas. Rationale: The hypoglycemic action of glyburide results from the stimulation of pancreatic beta cells, leading to increased insulin secretion.
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 Rationale: 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.
What information regarding metformin therapy would the nurse include during client education?
it does not increase insulin levels. Rationale: The drug class, biguanides, sensitizes the liver to circulating insulin levels, reduces intestinal glucose absorption, and reduces hepatic glucose production. Metformin, the only drug approved for U.S. use from the biguanide class, is the first choice drug used for initial Type 2 diabetes or when a pre-diabetic client is started on antidiabetic drug therapy. This drug is usually started alone in what is called, monotherapy. These drugs do not increase insulin levels or cause weight gain.
The nurse is caring for a client taking bromocriptine. What is an advantage of this medication?
reduces risk of heart attack or stroke. Rationale: Bromocriptine therapy clients had improved HbA1c levels, showing better glycemic control, and were less likely to have a heart attack or stroke or to die of heart disease. All drugs have adverse effects. Taking the medication four times a day and the need for long-term studies are not advantages of the drug.
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 Rationale: 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.
Chapter 42 Review: Prepare for NCLEX: Alternate-Format Questions #8 List in order the following steps in drawing up two types of insulin.
1. Inject air into the regular insulin vial, and invert and withdraw the prescribed amount. 2. Remove the needle from the vial without getting fluid (insulin) on the needle 3. Remove air bubbles from syringe, and withdraw the Humulin N insulin prescribed. 4. After cleansing both vials, inject air into the Humulin N insulin vial. **Rotate vials, do not shake!
The nurse is interviewing a client who was diagnosed with type 2 diabetes four months ago. The client does not record glucometer readings. What laboratory test does the nurse anticipate the health care provider will order for this client?
HbA1c Rationale: The nurse anticipates that the glycosylated hemoglobin (HbA1c) will be ordered for this client because it provides an average of the client's blood glucose level for the last three- to four-month period. It will also tell how well controlled the client's blood glucose is. A stat urine for glucose and an FBG in the AM will only indicate the client's current blood glucose level, not how well it is being controlled. An insulin level will not give the information needed to understand the client's control of blood glucose.
The home care nurse is caring for an older adult client who has type 1 diabetes. The client has visual impairment and cannot read the numbers on the syringe when preparing insulin for administration nor afford the cost of prefilled auto syringes. What strategy might the nurse use to help this client comply with insulin needs between visits?
Prepare a week's supply of syringes and refrigerate. Rationale: Older adults can have many underlying problems that complicate diabetic therapy. Poor vision and/or coordination may make it difficult to prepare a syringe. A week's supply of syringes can be prepared and refrigerated for the usual dose of insulin. If the client is using insulin, it is most likely because oral antidiabetic medications don't work. A magnifying glass is impractical because drawing up medication requires two hands and a magnifying glass will not help the client to see well enough to be safe. It is a big imposition to expect a neighbor to be constantly available and this would not be the best choice.
The nurse in the emergency department receives a conscious client following a motor vehicle accident who has no known history of diabetes but whose blood glucose level is 325 mg/dL. What rationale does the nurse provide explaining this elevated blood glucose level?
The client's stress reaction likely caused an increase in blood sugar. Rationale: The stress reaction elevates the blood glucose concentration above the normal range. In severe stress situations, the blood glucose level can be very high (300 to 400 mg/dL). The body uses that energy to fight the insult or flee from the stressor. It would be unlikely for a hyperglycemic episode to cause a change in consciousness that would result in an accident. Eating food does not cause such a large increase in glucose levels. Pancreatic trauma does not normally cause a precipitous increase in blood glucose levels.
A male patient is to begin glyburide (Diabeta) for type 2 diabetes. Before the drug therapy begins, a priority action by the nurse will be to assess the patient's
use of alcohol
The nurse is caring for a client taking insulin. The nurse realizes the client is experiencing symptoms of hypoglycemia when the client displays:
weakness, sweating, and decreased mentation
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 am on the middle school track team." Rationale: 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 client who is a newly diagnosed diabetic is prescribed glyburide. The nurse caring for this client identifies which occurrence is a classic symptom of hyperglycemia?
Excessive urination Rationale: The classic symptoms of hyperglycemia include excessive urination (polyuria) and excessive thirst (polydipsia) caused by the osmotic pull of glucose. Grand mal seizures and hemiparesis are symptoms of nonketotic hyperglycemia, while tachycardia is a symptom of diabetic ketoacidosis.
The nurse is administering an antidiabetic agent by subcutaneous injection within 60 minutes of the patient's breakfast. Which agent would the nurse most likely be administering?
Exenatide
Secondary Failure
In diabetes mellitus, is considered a loss of the effectiveness of sulfonylurea, an oral anti diabetic drug. Typically occurs when patient has been taking sulfonylureas for a period of time.
A patient is undergoing metformin therapy at a health care facility. The patient is also prescribed glucocorticoids. What effect of interaction of these two drugs should the nurse assess for in the patient?
Increased risk of lactic acidosis
What is an example of rapid acting insulin?
Insulin lispro (Humalog)
You are the nurse educator at the diabetes clinic. When talking to a class of adolescent diabetics, you tell them that the main methods of self-monitoring glycemic control are testing of
blood glucose and urine ketone levels.
The pathophysiology class is studying diabetes. A student asks the instructor what is considered a sign of a hypoglycemic reaction. The instructor's response would be:
diaphoresis.
Insulin is a hormone released by the pancreatic beta cells in response to a rise in glucose levels and what else?
incretins
Diabetes mellitus (DM) is a chronic disorder characteristics by insufficient __________ production by the beta cells of the pancreas.
insulin
