KARCH PHARM Chapter 38- Agents to Control Blood Glucose Levels

B

An type 1 (insulin-dependent) diabetic reports recurrent hypoglycemia late in the morning. After collecting his health history what finding would the nurse suspect is causing the late morning hypoglycemia?

A)

The patient likes to nap after work before his evening meal.

B)

The patient jogs 2 miles in the morning before he goes to work.

C)

The patient likes to have an early lunch with his girlfriend.

D)

The patient eats oatmeal early in the morning for breakfast.

B

The nurse suspects the diabetic patient may be having a hypoglycemic reaction when what manifestation is assessed?

A)

Dry, flaky skin

B)

Diaphoresis

C)

Flushing of the face

D)

Fruity breath

A

The nurse is preparing patient teaching for a diabetic patient who is to begin pramlintide acetate (Symlin) therapy, which will be taken in addition to insulin. What is the priority nursing instruction to include in this teaching plan?

A)

The drug is injected subcutaneously immediately before a major meal.

B)

The drug has a rapid onset of action.

C)

Inject the drug at least 2 inches away from any insulin injection site.

D)

Do not combine the drug with insulin in the same syringe.

D

What type of insulin would the nurse administer if the fastest therapeutic effects are needed?

A)

Lispro (Humalog)

B)

Aspart (NovoLog)

C)

Regular (Humulin R)

D)

Glulisine (Apidra)

A

When the nurse administers an oral combination drug called Metaglip, what doses of the two medications are being administered?

A)

2.5 mg glipizide, 500 mg metformin

B)

1.25 mg glyburide, 250 mg metformin

C)

5 mg glipizide, 250 mg metformin

D)

4 mg rosiglitazone, 500 mg metformin

D

The patient, newly diagnosed with diabetic retinopathy, asks what caused this disorder. What is the nurses best response?

A)

Inability of cells in the eye to reproduce

B)

Increase of aqueous humor in the eye

C)

Decrease of nerve innervations throughout the eye

D)

Oxygen cannot diffuse rapidly across the membrane to tissues in the eye

C

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?

A)

Blood pressure

B)

Bilirubin level

C)

Glycosylated hemoglobin (HbAlc) levels

D)

Fasting blood glucose levels

C

A patient is brought to the emergency department with severe hypoglycemia. What drug would the nurse prepare to administer intravenously?

A)

Diazole (Hyperstat)

B)

Glyburide (DiaBeta)

C)

Glucagon (GlucaGen)

D)

Insulin (Humulin R)

A

The nurse will question what medication order for a diabetic patient who takes insulin to control his blood sugar level?

A)

Propranolol (Inderal) 10 mg orally t.i.d.

B)

Furosemide (Lasix) 60 mg/d orally

C)

Cefaclor (Ceclor) 250 mg orally every 8 hour

D)

Metoclopramide (Reglan) 20 mg PO

C

A patient comes to the diabetes educator and asks about changing his insulin. The patient explains that his occupation takes him on long international flights and he does not want to administer insulin on the plane. What kind of insulin would the diabetic nurse educator seek an order for?

A)

Lispro (Humalog)

B)

Glulisine (Apidra)

C)

Ultralente (Humulin U Ultralente)

D)

Aspart (NovoLog)

B

The diabetes nurse educator describes type 1 diabetes with what statement?

A)

Blood glucose level can be controlled with diet.

B)

Exogenous insulin is required for life.

C)

Oral agents can help to control blood glucose levels.

D)

It is always diagnosed in early childhood.

D

A patient is admitted to the emergency department in diabetic ketoacidosis (DKA) with a blood glucose level of 485 mg/dL. The physician orders an initial dose of 25 U insulin IV. Which type of insulin will be administered?

A)

NPH insulin

B)

Humulin L insulin

C)

Humulin N insulin

D)

Regular insulin

B

What instructions would be important to give to a 50-year-old patient with type 2 diabetes who has been switched from glyburide (DiaBeta) to repaglinide?

A)

It is less potent, so you will need to take a larger dose.

B)

It stimulates insulin production, so you need to eat soon after taking the medication.

C)

It is more potent and longer lasting, so you should take it every other day.

D)

The two medications are virtually the same.

C

The nurse is instructing a patient how to mix NPH insulin with regular insulin in one syringe. The nurse tells the patient the mixture must be administered within how long after it is prepared?

A)

5 minutes

B)

10 minutes

C)

15 minutes

D)

20 minutes

A, B, C

The nurse is caring for a 3-year-old child newly diagnosed with type 1 diabetes. When developing the plan of care for this child, the nurse incorporates challenges the child faces that the adult does not, which includes what? (Select all that apply.)

A)

Children have a faster metabolic rate.

B)

Growth must be balanced with diet and activity.

C)

Insulin dose may be so small it is hard to calibrate accurately.

D)

Increased resistance by child to dietary restrictions is common.

E)

Changing metabolism makes regulating insulin difficult.

D

With what patient would the nurse question the administration of human insulin?

A)

Gestational diabetes

B)

Type 2 diabetes controlled on oral antidiabetic agents with systemic infection

C)

Type 1 diabetes of many years

D)

Type 2 diabetes controlled by diet

A, B, C, D

The nurse is teaching the patient about the newly prescribed external insulin pump. What are priority teaching points for the nurse to include? (Select all that apply.)

A)

Watch for signs and symptoms of infection.

B)

Check blood glucose frequently.

C)

Change tubing frequently.

D)

Have pump calibrated weekly.

E)

Added insulin requires separate injection site.

D

The nurse, working in the emergency department, receives a patient following a motor vehicle accident whose medical history is unknown with a blood glucose level of 325 mg/dL. What rationale does the nurse provide explaining this elevated blood glucose level?

A)

The patients accident was caused by diabetic ketoacidosis (DKA).

B)

The patient has not been taking the antidiabetic agent as prescribed.

C)

The patient most likely just finished a meal.

D)

The stress reaction caused an increase in blood sugar.

B

A patient with type 2 diabetes presents at the clinic for a routine follow-up appointment. The patient asks the nurse whether she can take the herbal supplement ginseng. What is the correct response by the nurse?

A)

It increases the risk for high blood glucose levels.

B)

It increases the risk for low blood glucose levels.

C)

There is no research to indicate what effect it will have.

D)

There is no reason ginseng cannot be taken by people with diabetes.

A

The nurse is performing diabetes screening and recognizes what ethnic group is at higher risk for diabetes but is also predisposed to a higher normal range of blood glucose?

A)

Native Americans

B)

Japanese Americans

C)

African Americans

D)

Caucasian Americans

A

The nurse is caring for a patient with renal dysfunction who requires an oral antidiabetic agent. What drug will the nurse expect to see ordered?

A)

Tolbutamide

B)

Chlorpropamide

C)

Tolazamide

D)

Chlorpromazine

A

A patient with type 1 diabetes takes 12 units of regular insulin and 34 units of NPH insulin in the morning. How would the nurse explain why two different types of insulin are required to control the patients blood sugar?

A)

Different onsets and peak effects extends blood glucose control.

B)

The mixture makes each drug work more effectively.

C)

The combination reduces the adverse effects experienced.

D)

Patients are less likely to experience hypoglycemia.

D

What antidiabetic agent is approved for the nurse to administer to children 10 years old and older with type 2 diabetes?

A)

Pioglitazone

B)

Repaglinide

C)

Liraglutide

D)

Metformin

C

The nurse is caring for a pregnant patient diagnosed with pregnancy-induced diabetes. What antidiabetic agent is best suited for administration to this patient?

A)

Metformin

B)

Acarbose

C)

Insulin

D)

Glyburide

B

The home care nurse is caring for an older adult patient with visual impairment who cannot see the numbers on the syringe when preparing insulin for administration and cannot afford the increased cost of prefilled auto syringes. What strategy might the nurse use to help this patient comply with insulin needs between visits?

A)

Change the patient to oral antidiabetics.

B)

Prepare a weeks supply of syringes and refrigerate.

C)

Have the patient use a magnifying glass.

D)

Ask a neighbor to come over every day to prepare the medication.

A, C, E

The nurse admits a patient to the emergency department and recognizes the patient is in diabetic ketoacidosis (DKA) when what manifestations are assessed? (Select all that apply.)

A)

Fruity breath

B)

Edema

C)

Dehydration

D)

Agitation

E)

slow and deep respirations

B

The patient with diabetes asks the nurse why different oral antidiabetic agents are ordered instead of just one drug. What is the nurses best explanation of the benefit of combining different agents?

A)

Maximum effects

B)

Additive effects

C)

Minimalistic effects

D)

Synergistic effects

A

The nurse is caring for an obese woman who was just diagnosed with type 2 diabetes. When developing this patients plan of care, what is the priority nursing diagnosis?

A)

Imbalanced nutrition: more than body requirements related to obesity

B)

Risk for unstable blood glucose related to ineffective dosing of antidiabetic agents

C)

Disturbed sensory perception related to glucose levels

D)

Ineffective coping related to diagnosis and therapy

D

What outcome would best indicate the nurses teaching was effective and that drug therapy was appropriate?

A)

The patient can explain how to take the medication.

B)

The patient demonstrates the correct procedure for monitoring blood sugar.

C)

The patient follows an appropriate diet.

D)

Blood glucose level is stable with no diabetic complications.

D

The nurse is caring for a postoperative patient whose diabetes has been well controlled on acarbose (Precose). The patient is not allowed to take anything orally following abdominal surgery and is receiving high-glucose total parenteral nutrition via a central IV line. What medication can the nurse administer IV to control the patients blood glucose level?

A)

Glyburide

B)

Acarbose

C)

NPH insulin

D)

Regular insulin

A

The nurse is caring for a patient with polycystic ovary syndrome. What antidiabetic drug would the nurse anticipate will be ordered?

A)

Metformin

B)

Acarbose

C)

Insulin

D)

Glyburide

A, B, C

The nurse is caring for an adolescent newly diagnosed with type 1 diabetes. The patient says, I cant believe Im going to spend the rest of my life sticking myself with needles. What future possibilities for insulin delivery can the nurse share with this patient? (Select all that apply.)

A)

Implantable insulin pump

B)

Insulin patch

C)

Inhaled insulin

D)

Oral insulin

E)

Pancreas transplant

A

The nurse is caring for a patient taking Bromocriptine (Cycloset). What is an advantage of this medication?

A)

Reduces risk of heart attack or stroke

B)

Has no adverse effects

C)

Is taken four times a day

D)

Long-term studies needed

C

The nurse transcribes an order for chlorpropamide (Diabinese). What is an appropriate dosage range for this medication?

A)

0.25 to 3 g per day

B)

2 mg per day

C)

100 to 250 mg per day

D)

5 mg orally daily

C

What is the maximum daily dosage of metformin the nurse can administer to a child aged 10 to 16 years?

A)

500 mg

B)

850 mg

C)

2,000 mg

D)

2,550 mg