Chapter 13 - Book Qs & Evolve

Question 1

1. What is the direct goal of drug therapy for diabetes mellitus?

A. To cure diabetes B. To prevent blindness C. To keep blood glucose levels within the normal range D. To improve body weight and reduce the risk for hypoglycemia

Answer 1

C

Question 2

2. How does the drug glucagon work to treat hypoglycemia?

A. It acts on the liver to release stored glucose from glycogen. B. It is a concentrated form of glucose in which 1mL is equal to 50g of glucose. C. Glucagon inactivates circulating insulin, thus preventing blood glucose levels from decreasing. D. Glucagon prevents insulin from binding to insulin receptors, thus acting as an insulin antagonist.

Answer 2

A

Question 3

3. Which signs and symptoms are associated with hypoglycemia or “insulin shock”? Select all that apply.

A. Acute confusion B. Cool clammy skin C. Deep rapid respirations D. Fruity odor of the breath E. Headache F. Increased sweating G. Nausea

Answer 3

A, B, E, F

Question 4

4. Which problem is a possible adverse effect of a drug from the sodium-glucose cotransport inhibitor class?

A. Injection site irritation or infection B. Increased respiratory infections C. Congestive heart failure D. Dehydration

Answer 4

D

Question 5

5. Which noninsulin antidiabetic drug can cause severe sunburn?

A. metformin (Glucophage) B. rosiglitazone (Avandia) C. glyburide (Micronase) D. nateglinide (Starlix)

Answer 5

C

Question 6

6. A patient with type 1 diabetes (DM1) asks why insulin must be injected instead of taken as a tablet. What is your best answer?

A. “Injecting insulin increases how fast it can work to control your diabetes.” B. “Insulin is a small protein that would be destroyed in the digestive system if swallowed.” C. “The absorption of oral insulin is so slow that the dose cannot be controlled and the effects are unpredictable.” D. “Injectable insulin more closely resembles the natural insulin that your pancreas makes compared with liquid oral insulin.”

Answer 6

B

Question 7

7. Why can people with type 2 diabetes (DM2) use noninsulin antidiabetic drugs to control the disease?

A. In people with DM2, the liver is able to take over the endocrine functions of the nonfunctional pancreas. B. DM2 is a mild disease that does not have severe long-term complications. C. Ketoacidosis develops only rarely among people who have type 2 diabetes. D. People with DM2 continue to make pancreatic insulin.

Answer 7

D

Question 8

8. When starting to draw up and administer a dose of NPH insulin, you find that the insulin in the vial is uniformly cloudy. What is your best action?

A. Shake the vial vigorously. B. Draw up the medication. C. Add normal saline. D. Open a new vial.

Answer 8

B

Question 9

9. What is the most important issue to teach a patient who uses short-acting insulin before meals?

A. “Shake the bottle before drawing up the insulin so that it is well mixed.” B. “Rotate the injection site to prevent the development of skin problems.” C. “Rub the injection site for 1 minute to ensure best drug absorption.” D. “Eat a meal within 15 minutes of injecting the drug.”

Answer 9

D

Question 10

10. A patient who uses insulin reports the area where he usually injects the drug is warm, red, and painful. What should you tell him to do?

A. Apply ice to the site for 10 minutes 4 times daily. B. Immediately call the prescriber and report these symptoms. C. Discard the bottle of insulin you have been using and open a fresh one. D. Go immediately to the emergency department to have the insulin injected intravenously.

Answer 10

B

Question 11

11. Which statement made by a patient newly diagnosed with DM1 indicates a need for more teaching?

A. I will keep a syringe and insulin bottle in my pocket at all times. B. I will always eat within 5 to 10 minutes of taking my dose of regular insulin. C. I will rotate my insulin injections within one site rather than switching injection sites. D. I will not share my insulin syringes or needles with my brother who also has diabetes.

Answer 11

A

Question 12

12. With which noninsulin antidiabetic drug should you remain alert for the possibility of hypoglycemia even when it is the only drug prescribed? (Select all that apply.)

A. acarbose (Precose) B. canagliflozin (Invokana) C. glipizide (Glucotrol) D. miglitol (Glyset) E. pioglitazone (Actos) F. repaglinide (Prandin) G. Rosiglitazone (Avandia) H. sitagliptin (Januvia)

Answer 12

B, C, F, H

Question 13

13. An older adult patient with type 2 diabetes who has been taking rosiglitazone (Avandia) for 1 month tells you that her urine is the color of coffee. What is your best action?

A. Document this patient report as the only action. B. Encourage the patient to drink more water. C. Test the patient’s urine for ketone bodies. D. Notify the prescriber immediately.

Answer 13

D

Question 14

A patient with diabetes is scheduled for an angiogram. What antidiabetic medication does the nurse tell the patient to avoid within 48 hours after the procedure?

Insulin

Glipizide (Glucotrol)

Metformin (Glucophage)

Rosiglitazone (Avandia)

Answer 14

Metformin (Glucophage)

Tests that involve the use of radio-opaque dye (such as urograms, angiograms, and other scans) can lead to kidney failure with metformin, usually within 48 hours. A patient who takes metformin may take the dose before receiving the dye but should not resume the drug again until 48 hours after testing with dye or surgery, with anesthesia, or until good urine output has been reestablished. Insulin use, glipizide, and rosiglitazone are not contraindicated with tests that use radiopaque dyes.

Question 15

Which precaution is most important to teach a patient who is newly prescribed sitagliptin (Januvia)?

Avoid caffeine while taking this drug.

Do not inject the drug into the same site as insulin.

Take a missed dose as soon as possible.

Report symptoms of infection to the prescriber immediately.

Answer 15

Take a missed dose as soon as possible.

Sitagliptin is taken just once daily. A missed dose should be taken as soon as it is remembered unless it is almost time for the next dose. It should not be taken more than once daily.

Question 16

The nurse is caring for a 12-year-old child with type 2 diabetes who has been ordered an adult dose of metformin (Glucophage). What should the nurse do next?

Question the order.

Ensure the child has a large enough body size.

Give the medication.

Reduce the child’s dose to half of the adult dose.

Answer 16

Give the medication.

Give the medication because the dose of metformin (Glucophage) for children over 10 years of age could be the same as for an adult. The dose of the drug is based upon response, not size, so this order does not need to be questioned. Reducing the dose by half would be an incorrect dose.

Question 17

A diabetic patient has been prescribed exenatide (Byetta). The nurse knows that what is the mechanism of action for this drug?

It triggers the pancreas to release insulin to handle the glucose ingested.

It makes insulin receptors more sensitive to insulin.

It increases the emptying time of the stomach.

It breaks down glycogen into glucose.

Answer 17

It triggers the pancreas to release insulin to handle the glucose ingested.

Exenatide (Byetta) is an incretin mimetic (GLp-1 agonists) and a member of a class of noninsulin antidiabetic drugs that work by acting like natural “gut” hormones that are secreted with meals at the same time insulin is secreted. Byetta triggers the pancreas to release insulin to handle the glucose. Insulin sensitizers (noninsulin antidiabetic drugs) like biguanides and thiazolidinediones (glitazones) make insulin receptors more sensitive to insulin. Exenatide does not increasine gastric emptying. Glucagon and not exenatide prevents hypoglycemia by breaking down glycogen into glucose.

Question 18

The nurse is caring for a patient with diabetes. The nurse knows that the goal for all diabetic drug therapy is?

hypoglycemia.

hyperglycemia.

euglycemia.

insulin shock.

Answer 18

euglycemia.

Euglycemia is a normal fasting blood glucose level (between 70 and 110 mg/dL) and the goal for diabetic drug therapy. Hyperglycemia is a blood glucose level above normal (higher than 110 mg/dL when fasting). Hypoglycemia is a blood glucose level below normal (lower than 70 mg/dL). Low blood glucose levels reduce body metabolism because not enough glucose enters cells to make adequate amounts of ATP. If hypoglycemia is severe enough, it can quickly lead to insulin shock and death. Insulin shock is dangerous because brain cells are very sensitive to low blood glucose levels and the patient can become nonresponsive very quickly. If left uncorrected quickly, the patient can die.

Question 19

The nurse is caring for a patient with diabetes. The nurse knows that what type of insulin is typically given before a meal?

Short acting

Intermediate acting

Long acting

Correction scale

Answer 19

Short acting

Whenever short-acting insulin is given before a meal, the meal should be eaten within 15 minutes after receiving the injection to avoid hypoglycemia. Intermediate-acting insulin (Humulin N) by itself has an onset of 1.5 hours. It also may be given in combination with other insulins before breakfast to help manage glucose levels throughout the day. Patients using long-acting insulin (onset of action of 1 to 2 hours) usually inject it at the beginning of the day for a basal dose. The total amount of insulin needed or coverage and how often it is needed for blood glucose control varies among patients. The patient checks his or her blood glucose level 2 to 12 times each day based on an insulin correction scale, activity level, age, the total amount of calories needed in a day, and how his or her blood glucose level responds to the insulin. Correction scales are less effective in covering a premeal high blood sugar, because the high blood glucose correction and food bolus cannot be split. Also, the correction scale method does not accommodate changes in insulin needs related to snacks or to stress and activity. Carbohydrates still need to be counted.

Question 20

The nurse is preparing to administer an insulin injection to a patient. After cleansing the site with an alcohol swab, grasping a fold of skin in the nondominant hand, and inserting the needle, what should the nurse do next?

Aspirate for blood; massage the site after removing the needle.

Do not aspirate for blood; massage the site after removing the needle.

Aspirate for blood; do not massage the site after removing the needle.

Do not aspirate for blood; do not massage the site after removing the needle.

Answer 20

Do not aspirate for blood; do not massage the site after removing the needle.

After inserting the needle, inject the insulin without aspirating for blood. It is not necessary to check for blood return and may cause bruising to the skin. Next, push the plunger all the way down to ensure that the entire insulin dose is injected. Release the fold of skin and remove the needle straight out quickly. Do not rub or massage the spot where you injected the insulin. Place the syringe with the needle (without recapping it) into a puncture-proof container.

Question 21

Before administering intermediate-acting insulin to a patient, the nurse notices that the insulin vial is cloudy. What should the nurse do next?

Give the medication as ordered.

Shake the bottle.

Obtain a vial that is clear.

Allow the sediment to settle.

Answer 21

Give the medication as ordered.

Check all insulin for color and clarity. Intermediate-acting insulin is supposed to be cloudy. Gently rotate the bottle or container between the palms of your hands to mix the insulin. Do not shake an insulin container before drawing up the drug because bubbles will form and the dose may not be accurate. Rapid-acting insulin, short-acting insulin, insulin glargine, or insulin detemir are supposed to be clear. If particles are present or if the insulin is cloudy, discard the bottle and open a new one. All other insulin types have a cloudy appearance after they have been gently rotated. Allowing sediment in insulin to settle should never be done.

Question 22

A patient took a dose of short-acting regular insulin at 0730. At which time should the nurse monitor the patient closely for hypoglycemia caused by the insulin peaking?

0800

1100

1400

2000

Answer 22

1100

1100 is within the expected peak time of 2 to 4 hours following injection of short-acting regular insulin. 0800 is within the expected time for onset of action, but not the peak time. 1400 is past the expected peak time of regular insulin. 2000 is well past the expected peak time of regular insulin. Regardless of the type of regimen, whenever short-acting insulin is given before a meal, the meal should be eaten within 15 minutes after receiving the injection to avoid hypoglycemia.

Question 23

The nurse is caring for a group of diabetic patients. What type of diabetes is more common and is linked with obesity and a sedentary lifestyle?

Diabetes mellitus type 1 (DM1)

Diabetes mellitus type 2 (DM2)

Juvenile

Insulin-dependent

Answer 23

Diabetes mellitus type 2 (DM2)

The biggest risk factors for developing DM2 are obesity and a sedentary lifestyle. With DM2 the person still has beta cells that make some insulin; however, the insulin receptors are not very sensitive to insulin. As a result, insulin does not bind as tightly to its receptors as it should, and less glucose moves from the blood into the cells. So hyperglycemia is present with DM2. Because some insulin is made and used with DM2, the symptoms are much more gradual in onset than those of DM1. In addition, because some glucose does get into the cells, fat is not used for fuel in DM2, and the person usually does not develop ketoacidosis. Type 1 diabetes (DM1) results when the beta cells of the pancreas no longer make and secrete any insulin. Without insulin the patient’s blood glucose level becomes very high, but glucose cannot enter many cells. The body then switches from using glucose to using fat to make ATP. As a result, the body has less ATP available. Patients who have DM1 are insulin dependent and must use insulin daily for the rest of their lives or receive a pancreas transplant.

Question 24

When mixing 10 units of regular insulin with 20 units of NPH insulin, the nurse knows that what is the proper order of steps for drawing up an insulin injection after cleaning the rubber stoppers of each bottle with separate alcohol swabs? (1) Inject 10 units of air into the regular insulin bottle. (2) Inject 20 units of air into the NPH bottle. (3) Withdraw 10 units of regular insulin into the syringe. (4) Withdraw 20 units of NPH insulin into the syringe. (5) Make sure the syringe is free from air bubbles.

2, 1, 3, 5, 4

2, 1, 4, 5, 3

1, 2, 3, 5, 4

1, 2, 4, 5, 3

Answer 24

2, 1, 3, 5, 4

After checking to make sure that you have the correct concentration and types of insulin, clean the rubber stoppers of each bottle with separate alcohol swabs. Draw up 20 units of air and inject it into the NPH bottle with the bottle in its normal, upright position. Always inject the air into the intermediate-acting insulin bottle first. The amount of air injected is the same amount as the insulin to be removed. Draw up 10 units of air and inject it into the regular insulin (short-acting insulin) bottle with the bottle in its normal, upright position. The amount of air injected is the same as the amount of insulin to be removed. Without removing the needle, turn the bottle upside down and withdraw 10 units of regular insulin; then withdraw the needle from the bottle. Always withdraw the shorter-acting insulin first. Make sure that the syringe is free from air bubbles. Now place the same needle with the syringe attached into the NPH bottle, invert the bottle, and withdraw 20 units of NPH insulin into the same syringe with the regular insulin. Take care not to inject any regular insulin into the NPH bottle. Check the syringe for the volume of insulin. There should now be 30 units in the syringe. See Box 13-4.