Unit3: Ch 38- Agents to Control Blood Glucose Levels (Karch 7th Ed) Flashcards
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.
Ans: B
Feedback:
Physical exercise, such as jogging, changes insulin requirements and may result in a delayed
hypoglycemic reaction. The fact that he likes to nap before dinner and has an early lunch is unrelated to
his hypoglycemia. The patient eating oatmeal early in the morning would help stabilize his blood
sugars until later in the morning, but the jogging would have a dramatic effect.
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
Ans: B
Feedback:
Diaphoresis and cool clammy skin are signs of hypoglycemia. A fruity breath is seen with ketoacidosis.
Flushing of the face is associated with hyperglycemia.
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.
Ans: A
Feedback:
Pramlintide works to modulate gastric emptying after a meal, so correct timing of administration of this
drug is essential to its function. All options are appropriate instructions for this drug. However, making
sure that the patient understands that injecting the medication immediately before eating a major meal
is most important because it has a dramatic effect on the therapeutic action of the drug. If the
medication is not given at the correct time, the other options would be insignificant.
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)
Ans: D
Feedback:
Glulisine has an onset of 2 to 5 minutes and peaks in 30 to 90 minutes so it has the fastest onset of
action. Lispro has an onset in <15 minutes and also peaks at 30 to 90 minutes. Aspart takes 10 to 20
minutes for onset and peeks in 1 to 3 hours. Regular insulin has a 30 to 60 minute onset and peaks in 2
to 4 hours.
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
Ans: A
Feedback:
Metaglip is a combination of 2.5 mg glipizide with 250 or 500 mg metformin or 5 mg glipizide and 500
mg metformin. Glucovance is a combination of 1.25 mg glyburide with 250 mg metformin, 2.5 mg
glyburide with 500 mg metformin, and 5 mg glyburide with 500 mg of metformin. Avandamet is a
combination of 1, 2, or 4 mg rosiglitazone with 500 mg metformin.
The patient, newly diagnosed with diabetic retinopathy, asks what caused this disorder. What is the
nurse’s 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
Ans: D
Feedback:
The body’s inability to effectively cope with carbohydrate, fat, and protein metabolism over a long
period of time results in a thickening of the basement membrane in large and small blood vessels. This
thickening leads to changes in oxygenation of the lining of the vessels causing damage and narrowing
of the vessels. The decreased blood flow through the vessels results in the inability of oxygen to rapidly
diffuse across the membrane to the tissues of the eye. The tiny vessels of the eye are narrowed and
closed, which causes loss of vision. Increase of aqueous humor is seen in glaucoma. Inability of cell
replication and decrease in nerve innervations throughout the eye is not associated with retinopathy.
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
Ans: C
Feedback:
HbAlc levels provide a 3-month average of glucose levels, which provides the best evaluation tool to
measure the overall patient response to the treatment plan. Blood pressure readings would be used to
evaluate a patient’s response to an antihypertensive drug. Bilirubin could indicate liver function.
Fasting blood glucose levels provide only a baseline blood sugar and no historical overview.
Comparing fasting blood glucose levels with HbAlc is like comparing a picture to a video because the
HbAlc looks back across a period of 3 months whereas a blood glucose test result only tells you about
the exact moment the blood was drawn.
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)
Ans: C
Feedback:
This patient will need a glucose-elevating agent. Glucagon (GlucaGen) is given parenterally only and is
the preferred agent for emergency situations. Diazole is also a glucose-elevating agent but is only
administered so it would take longer to take effect. Insulin would be administered for hyperglycemia.
Glyburide is an oral antidiabetic agent, which is a second-generation sulfonylurea, and is administered
for hyperglycemia.
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
Ans: A
Feedback:
Propranolol is a beta-blocker and should be avoided in combination with insulin. The blocking of the
sympathetic nervous system also blocks many of the signs and symptoms of hypoglycemia, hindering
the patient’s ability to recognize problems. If propranolol must be taken, the nurse will need to teach
this patient other ways to recognize hypoglycemia. Furosemide, cefaclor, and metoclopramide do not
cause drug drug interactions with insulin.
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)
Ans: C
Feedback:
Ultralente has a duration of 20 to 36 hours and a peak time of 10 to 30 hours. This would prevent him
having to administer insulin on the airplane. Lispro has a duration of 2 to 5 hours and a peak time of 30
to 90 minutes. Glulisine has a duration of 1 to 2.5 hours and a peak time of 30 to 90 minutes. Aspart has
a duration of 3 to 5 hours and a peak time of 1 to 3 hours. The last three insulin types mentioned in this
Rationale would likely require administration on long plane flights.
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.
Ans: B
Feedback:
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. In type 1 diabetes, blood glucose levels
cannot be controlled with diet, oral agents cannot control the disease process because they stimulate
insulin production, and the patient with type 1 diabetes does not produce insulin. It can be diagnosed at
other stages of the life span than just in early childhood.
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
Ans: D
Feedback:
Regular insulin is a short-acting insulin that manages the hyperglycemia and hyperkalemia resulting
from DKA, which is a life-threatening complication that occurs with severe insulin deficiency.
Furthermore, only regular insulin can be given IV and is the drug of choice in emergency situations.
Humulin N, Humulin L, and NPH are intermediate-acting forms.
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.
Ans: B
Feedback:
Glyburide is a second-generation sulfonylurea that stimulates insulin release from the beta cells in the
pancreas with a 2- to 4-hour onset of action. Repaglinide has an onset of action within 30 minutes with
peak effect in 1 hour, and duration of action is approximately 3 to 4 hours. Because repaglinide has a
much faster onset of action, it is important the patient eats within15 to 30 minutes after taking the drug
to avoid hypoglycemia. Repaglinide is not less potent, it is not more potent, and the two medications are not virtually the same.
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
Ans: C
Feedback:
Use caution when mixing types of insulin. Administer mixtures of regular and NPH or regular and
lente insulins within 15 minutes after combining them to ensure appropriate suspension and therapeutic
effect.
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.
Ans: A, B, C
Feedback:
Treatment of diabetes in children is a difficult challenge of balancing diet, activity, growth, stressors,
and insulin requirements. Children need to be carefully monitored for any sign of hypoglycemia or
hyperglycemia and treated quickly because their fast metabolism and lack of body reserves can push
them into a severe state quickly. Insulin dosage, especially in infants, may be so small that it is difficult
to calibrate. Insulin often needs to be diluted to a volume that can be detected on the syringe. It is
usually during adolescence when increased resistance to dietary restrictions and changing metabolism
makes regulating insulin difficult so this would not be part of the plan of care for a 3-year-old.