NURS 317 Unit 3 Chapter 38 Pharm Point Questions Flashcards
Which insulin would the nurse need to administer as a separate injection if the order also included NPH insulin?
A) Regular
B) Aspart
C) Lispro
D) Glargine
D) Glargine
Rationale:Insulin glargine cannot be mixed in solution with any other insulin.
Glycosylated hemoglobin levels provide reliable evidence of blood glucose control.
A) TRUE
B) FALSE
A) TRUE
Rationale:Glycosylated hemoglobin levels, or an HbA1c test, provide a 3-month average of glucose levels. Red blood cells are freely permeable to glucose, and this test gives an average range of glucose exposure over the life of the red blood cell, about 120 days. This test does not require fasting before blood is drawn or the oral intake of glucose before testing. Elevations above 6% may be an early indicator of a prediabetic state, before changes are noted in the fasting blood sugar level. Once a baseline is established, the goal of therapy for a diabetic client is an HbA1c level less than 7%.
The nurse discovers the client is hypoglycemic. What drug will the nurse administer intravenously to increase blood sugar level?
A) Glucagon, 0.5 to 1 mg
B) Chlorpropamide, 100 to 250 mg
C) Diazoxide, 3 to 8 mg/kg
D) Nateglinide, 120 mg
A) Glucagon, 0.5 to 1 mg
Rationale:Glucagon can be given IV, but diazoxide would be given PO. Both drugs increase blood sugar levels. Nateglinide and chlorpropamide would further lower blood sugar
When administering insulin, what nursing action would be most appropriate?
A) Shake the vial vigorously to ensure thorough mixing before drawing up the dose.
B) Insert the needle at a 45-degree angle for injection.
C) Massage the injection site firmly after removing the needle and syringe.
D) Firmly spread the skin of the area of the intended site of injection.
B) Insert the needle at a 45-degree angle for injection.
Rationale:The needle is inserted at a 45-degree angle for subcutaneous administration. The vial should be gently rotated, and vigorous shaking is to be avoided to ensure uniform suspension of the insulin. Typically, the area is pinched to allow access to the loose connective tissue layer. Gentle pressure should be applied at the injection site.
The nurse assesses a client after administering insulin and finds that the client is stuporous with a glucose level of 24 mg/dL. What is the nurse’s priority action?
A) Administer 4 to 6 units of lispro insulin as prescribed.
B) Provide the client with 8 oz of orange juice.
C) Administer glucagon as prescribed.
D) Administer 4 to 6 units of glulisine insulin as prescribed.
C) Administer glucagon as prescribed.
Rationale:Blood glucose levels below 40 mg/dL are indicative of severe hypoglycemia. This client is likely to require glucagon. Giving juice by mouth would be dangerous if the client’s level of consciousness is reduced. Insulin of any type would exacerbate the client’s condition.
What drugs would the nurse classify as second-generation sulfonylureas? Select all that apply.
A) Glyburide
B) Glimepiride
C) Repaglinide
D) Tolazamide
E) Pramlintide
A) Glyburide
B) Glimepiride
D) Tolazamide
Rationale:Glimepiride is a second-generation sulfonylurea. Glyburide is a second-generation sulfonylurea. Tolazamide is a first-generation sulfonylurea. Pramlintide is a human amylin agent. Repaglinide is a meglitinides agent.
The nurse teaches the client who is newly diagnosed with diabetes that the initial reaction to falling blood glucose that serves as a warning to check blood sugar levels will be what?
A) Thirst
B) Kussmaul respirations
C) Increased GI activity
D) Diaphoresis
C) Increased GI activity
Rationale:The initial reaction to falling blood glucose level is parasympathetic stimulation—increased GI activity to increase digestion and absorption. Rather rapidly, the SNS responds with a “fight-or-flight” reaction that increases blood glucose levels by initiating the breakdown of fat and glycogen to release glucose for rapid energy. Diaphoresis is a later symptom. Kussmaul respirations and thirst are signs of hyperglycemia.
Pramlintide is administered orally.
A) FALSE
B) TRUE
A) FALSE
Rationale:Pramlintide is administered by subcutaneous injection.
The nurse is caring for a client with type 2 diabetes who also has an inflammatory condition requiring corticosteroids. What is the nurse’s best action?
A) Monitor the client’s glucose levels more frequently than usual.
B) Collaborate with the provider to temporarily reduce hypoglycemic medications.
C) Assess the client for signs of diabetic ketoacidosis (DKA).
D) Administer supplementary doses of regular insulin as prescribed.
A) Monitor the client’s glucose levels more frequently than usual.
Rationale:Corticosteroids tend to increase blood glucose levels, creating a need for careful monitoring. The client may need more, not less, medication. DKA is exclusive to type 1 diabetes. For this client, insulin would only be necessary in cases of extreme hyperglycemia.
A client receives a dose of insulin lispro at 8 AM. The nurse would assess most carefully for signs and symptoms of possible hypoglycemia at what time?
A) Between 10 AM and 12 noon
B) Between 2 and 4 PM
C) Between 8:30 and 9:30 AM
D) Between 12 noon and 8 PM
C) Between 8:30 and 9:30 AM
Rationale:With insulin lispro, peak effects would occur in 30 to 90 minutes, or between 8:30 and 9:30 AM. Regular insulin peaks in 2 to 4 hours. With insulin detemir, peak effects would occur in 6 to 8 hours, or between 2 and 4 PM. With NPH insulin, peak effects would occur in 4 to 12 hours, or between 12 noon and 8 PM.
A client is receiving acarbose. What would the nurse incorporate into the teaching plan for this client to explain the action of the drug?
A) Decreases insulin resistance
B) Inhibits an enzyme to delay glucose absorption
C) Binds to potassium channels on pancreatic beta cells
D) Increases the uptake of glucose
B) Inhibits an enzyme to delay glucose absorption
Rationale:Acarbose inhibits alpha glucosidase, an enzyme, thereby delaying the absorption of glucose. Thiazolidinediones, such as rosiglitazone, decrease insulin resistance. Second-generation sulfonylureas bind to potassium channels on the pancreatic beta cells to improve insulin binding to insulin receptors and increase the number of insulin receptors. Biguanides, such as metformin, increase the uptake of glucose.
A client is prescribed sitagliptin. The nurse would expect to administer this drug by which route?
A) Intramuscular
B) Oral
C) Intravenous
D) Subcutaneous
B) Oral
Rationale:Sitagliptin is administered orally.
When preparing to administer a combination of two insulins for a client with type 1 diabetes, what combination is most likely?
A) Detemir and glulisine
B) Glargine and aspart
C) NPH and regular
D) Detemir and regular
C) NPH and regular
Rationale:A combination of NPH and regular insulin is among the most common combinations that are used in practice. Detemir and glargine cannot be safely mixed with any other insulin
Clients with type 2 diabetes have nonfunctioning beta pancreatic cells.
A) FALSE
B) TRUE
A) FALSE
Rationale:Type 2 diabetes reflects an inability to produce enough insulin as needed or a change in insulin receptor sensitivity.
The nurse is administering an antidiabetic agent by subcutaneous injection within 60 minutes before the client’s breakfast. Which agent would the nurse most likely to be administering?
A) Rosiglitazone
B) Miglitol
C) Exenatide
D) Repaglinide
C) Exenatide
Rationale:Exenatide is administered by subcutaneous injection within 60 minutes before morning and evening meals. Rosiglitazone would be administered as a single oral dose. Repaglinide is used orally before meals. Miglitol is given orally with the first bite of each meal.
