Week 12: Chapter 13

Question 1

What is the direct goal therapy for diabetes mellitus?

Answer 1

To keep blood glucose levels within normal range

Question 2

How does the drug glucagon work to treat hypoglycemia?

Answer 2

It acts on the liver to release stored glucose from glycogen

Question 3

Which S/S are associated with hypoglycemia or insulin shock?

Answer 3

Acute confusion
Cool clammy skin
Headache
Increased sweating

Question 4

Which problem is a possible A/E of a drug from the sodium-glucose cotransport inhibitor class {canagliflozin (Invokana) and dapagliflozen (Farxiga)} ?

Answer 4

Dehydration

Question 5

Which non-insulin antidiabetic drug can cause severe sunburn?

Answer 5

glyburide (Micronase) {Insulin Secretagogauges}

Question 6

A pt with Type 1 DM asks why insulin must be injected in stead of taken as a tablet. What is your best answer?

Answer 6

Insulin is a small protein that would be destroyed in the digestive system if swallowed.

Question 7

Why can people with DM2 use non-insulin antidiabetic drugs to control the disease?

Answer 7

People with DM2 continue to make pancreatic insulin

Question 8

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

Answer 8

Draw up the medication

Question 9

What is the most important issue to teach a pt who uses short acting insulin {Humulin R, Novolin R, ReliON R} before meals?

Answer 9

Eat a meal within 15 min of injecting the drug

Question 10

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

Answer 10

Immediately call the prescriber and report the symptoms

Question 11

Which statement made by a pt newly dx with DM1 indicates a need for more teaching?

Answer 11

I will keep a syringe and insulin bottle in my pocket at all times

Question 12

With which non-insulin antidiabetic drugs(4) should you remain alert for the possibility of hypoglycemia even when it is the only drug prescribed?

Answer 12

1. canagliflozin (Invokana) {Sodium-Glucose Cotransport Inhibitor}
2. glipizide (Glucotrol) {Insulin Secretagogues}
3. repaglinide (Prandin) {Meglitindes}
4. sitagliptin (Januvia) {DPP-4 Inhibitors}

Question 13

An older adult pt with DM2 who has been taking rosiglitazone (Avandia) {Thiazolidinedione’s / giltazones} for 1 month tells that her urine is the color of coffee. What is your best action?

Answer 13

Notify the prescriber immediately

{rosiglitazone (Avandia)
Class: Insulin Sensitizer / Category: Thiazolidinedione}

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?

Answer 14

Metformin (Glucophage)

{Class: Insulin Sensitizer / Category: Biguanides}

Question 15

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

Answer 15

Take a missed dose as soon as possible.

sitagliptin (Januvia) {DPP-4 Inhibitor}

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?

Answer 16

Give the medication

metformin (Glucophage) {Class: Insulin Sensitizer / Category: Biguanides}

Question 17

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

Answer 17

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

exenatide (Byetta) {Incretin Mimetics (GLp-1 agonist)}

Question 18

The nurse is reviewing the actions of hormones. The nurse knows that what hormone is typically active early in the morning, or when the person is not eating, to maintain control of blood glucose levels?

Answer 18

Glucagon

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?

Answer 19

Short acting

Question 20

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

Answer 20

euglycemia {The condition or state in which the blood glucose level is within normal ranges}

Question 21

Before administering intermediate-acting insulin {Humulin N, Novolin N, ReliON N} to a patient, the nurse notices that the insulin vial is cloudy. What should the nurse do next?

Answer 21

Give the medication as ordered.

Question 22

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?

Answer 22

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

Question 23

Which signs and symptoms are associated with hypoglycemia? (select all that apply)

Answer 23

Shakiness, tremors
Headache
Sensation of hunger
Confusion

Question 24

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?

Answer 24

Diabetes mellitus type 2 (DM2)

Question 25

The nurse is performing discharge instructions to a patient with diabetes. What does the nurse tell the patient to do if an episode of sweating and shakiness appears after an injection of regular insulin ?

Answer 25

Eat something, preferably something sugary.

Question 26

The nurse is instructing a group of diabetic patients. What diabetic drug must the nurse tell the patients how to protect themselves from the sun?

Answer 26

Glipizide (Glucotrol)

{Class: Insulin Secretagogues / Category: Second-generation Sulfonylureas}

Question 27

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 {Intermediate-Acting Insulin} into the syringe. (5) Make sure the syringe is free from air bubbles.

Answer 27

2, 1, 3, 5, 4

(2) Inject 20 units of air into the NPH bottle.
(1) Inject 10 units of air into the regular insulin bottle.
(3) Withdraw 10 units of regular insulin into the syringe.
(5) Make sure the syringe is free from air bubbles.
(4) Withdraw 20 units of NPH insulin into the syringe.

Question 28

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?

Answer 28

1100

1100 is within the expected peak time of 2 to 4 hours following injection of short-acting regular insulin.

Question 29

List of Common Oral Combination Noninsulin Antidiabetic Drugs for DM2:

Answer 29

Metaglip = glipizide + metformin
Glucovance = glyburide + metformin
Avandamet = metformin + rosiglitazone
Avandadryl = rosigliazone and glimepiride