*NURSING > EXAM > CNA 101 Exam 3 - Diabetic Meds – North Seattle Community College | CNA101 Exam 3 - Diabetic Meds (All)
CNA 101 Exam 3 - Diabetic Meds – North Seattle Community College You are caring for a patient who is taking exenatide (Byetta) to treat type 2 DM. The patient reports severe abdominal pain. You sus... pect which of the following adverse reactions to this drug? A. Peptic ulcer disease B. Hyperkalemia C. Hyperglycemia D. Pancreatitis (Rationale: exenatide, an incretin mimetic agent, can cause acute pancreatitis. The patient is instructed to watch for and report severe or persistent abdominal pain, so the provider should now be informed and tell the patient to stop taking the drug. Exenatide is unlikely to cause hyperkalemia, an effect much more likely with insulin. Exenatide is more likely to cause hypoglycemia than hyperglycemia. Indications of hypoglycemia include tachycardia, diaphoresis, shakiness, and weakness.) You are caring for a patient who takes acarbose (Precose) and a sulfonylurea to treat type 2 DM. Which of the following is an indication of an adverse reaction to this drug combination? A. Polyuria B. Tremors C. Bradycardia D. Thirst (Rationale: This drug combo can cause hypoglycemia. Indications of hypoglycemic reaction include hunger, tachycardia, shakiness, tremors, and diaphoresis. Polyuria and thirst are indications of hyperglycemia, not hypoglycemia. Tachycardia, not bradycardia, is an indication of hypoglycemia. Acarbose, with or without sulfonylurea therapy, is unlikely to cause bradycardia.) A patient is about to start taking sustained release glipizide (Glucotrol) to treat type 2 DM. Which of the following instructions should you include when talking with the patient about taking his drug? A. Chew the tablet completely before swallowing it. B. Take it once a day, 30 min before selected meals. C. Take it in the evening before bedtime. D. Drink 16 oz. of water right after taking it. (Rationale: Take sustained-release glipizide, a sulfonylurea, 30 min before the first meal of the day. Other drugs in this category require 1-3 doses per day before selected meals. Do not crush or chew the sustained-release tablets. It is not necessary to drink 16 oz of water after taking the drug, but it is not harmful to do so, either. Because glipizide peaks in 1-2 hours, it is inappropriate to take it at bedtime and appropriate to have a meal after taking it.) When talking with a patient about self-administering regular insulin (Humulin R), you should include which of the following instructions? A. Shake the vial vigorously. B. Expect the solution to appear cloudy. C. Store unopened vials at room temperature. D. Inject the insulin subcutaneously. (Rationale: Do not shake the vial vigorously, but rotate it gently to disperse the particles. Do not use insulin that appears cloudy or discolored. Refrigerate unopened vials until their expiration date and keep opened vials at room temperature up to 1 month.) A patient will self-inject 8 units of NPH insulin and 4 units of regular insulin each day before breakfast. As you show the patient how to self-administer insulin, you should include which of the following instructions? (Select all that apply.) A. Draw the regular insulin into the syringe first, then the NPH insulin. B. Inject the insulin mixture into a large muscle. C. Discard any unused premixed syringes within 5 days. D. Use a 5-mL syringe when mixing two types of insulins. E. Use one syringe to reduce the number of injections. (Rationale: You should instruct the patient to draw the regular insulin into the syringe first to prevent mixing NPH insulin into the vial of regular insulin, which could cause a change in the onset of action of the regular insulin. The patient should inject insulin subcutaneously, not into a large muscle. The patient may store premixed syringes for 1-2 weeks refrigerated and vertical with the needles pointing upward. The patient should resuspend the insulin gently prior to injection, and must always use an insulin syringe to to prevent errors in dosing. The patient may mix NPH and regular insulin in the same syringe to reduce the number of injections. The patient should not mix insulin glargine or detemir with any other insulin.) You instruct a patient to watch for and report which of the following indications of an adverse reaction to insulin? A. Palpitations B. Weight gain C. Low urine output D. Constipation (Rationale: insulin can cause hypokalemia. You should monitor potassium levels and ECG and instruct the patient to watch for and report muscle weakness, nausea, palpitations, or paresthesias. Insulin can cause hypoglycemia, which causes tachycarida, palpitations, and diaphoresis. Insulin is unlikely to cause weight gain. Insulin is unlikely to cause reduced urine output, although hyperglycemia can cause polyuria. Insulin is unlikely to cause constipation.) As you talk with a patient about managing diabetes with regular insulin (Humulin R), you should include which of the following instructions? (Select all that apply.) A. Self-inject chilled insulin. B. Carry a carbohydrate snack. C. Rotate injection sites. D. Wear a medical alert bracelet. E. Expect to adjust the dosage during illness. (Rationale: Injectable insulin can cause lipohypertrophy, an accumulation of subcutaneous fat. Injecting room temperature insulin and rotating injection sites helps minimize this adverse effect. The patient should carry a carb snack with them at all times in case of hypoglycemia. They should also wear a medical alert bracelet in case of hypoglycemia that causes a loss of consciousness, so that healthcare professionals will know to administer glucose or glucagon parenterally. The patient should anticipate insulin dosage adjustments during stress, illness, infection, or pregnancy.) You give a patient 5 units of lispro insulin (Humalog) and 10 units of insulin glargine subcutaneously at 1400. Based on your instructions, the patient should expect their blood glucose levels to be the lowest at which of the following times? A. 1430 B. 1530 C. 1630 D. 1730 (Rationale: lispro insulin is a rapid-acting insulin that has an onset of <15 minutes and peaks at 30 minutes to an hour. The patient's glucose should be the lowest between 1430 and 1500. Lispro insulin has a duration of 3-4 hours, so the patient should continue to check her blood glucose and watch for indications of hypoglycemia, such as tremors, headache, and weakness. Insulin glargine does not have a peak and lasts up to 24 hours.) A patient who is taking metformin (Glucophage) to treat type 2 DM plans to undergo angiography using iodine-containing contrast dye. The health care professional should recognize that an interaction between metformin and the IV contrast dye can increase the patient's risk for which of the following? A. Hypokalemia B. Hyperglycemia C. Acute renal failure D. Acute pancreatitis (Rationale: metformin, a biguanide, can interact with iodine-containing contrast dye, causing acute renal failure and lactic acidosis. The health care professional should withhold metformin for 48 hours prior to and following the procedure. The health care professional should also monitor the patient for indications of acute renal failure or lactic acidosis, such as reduced urine output, hyperventilation, and abdominal pain.) When talking to a patient who is about to begin glipizide (Glucotrol) therapy to treat type 2 DM, the health care professional should include which of the following instructions? A. Avoid drinking alcohol. B. Sit or stand for 30 min after taking the drug. C. Urinate every 4 hr. D. Take the drug 2 hr after a meal. (Rationale: alcohol can interact with glipizide, a sulfonylurea, causing a reaction similar to disulfiram (Antabuse), manifesting as nausea, palpitations, and flushing. Alcohol also increases the drug's hypoglycemic effects.) A health care professional is caring for a patient who is about to begin acarbose (Precose) therapy to treat type 2 DM. Which of the following instructions should the health care professional include when talking with the patient about the drug? A. Eat more iron-rich foods. B. Avoid drinking grapefruit juice. C. Increase fiber intake. D. Avoid drinking green tea. (Rationale: acarbose, an alpha-glucosidase inhibitor, can cause iron-deficiency anemia. The health care professional should tell the patient to increase intake of iron-rich foods, such as red meat, spinach, and grains, and monitor the patient's CBC.) A primary care provider should prescribe a lower dose of sitaglipitin (Januvia) for a patient who has type 2 DM and who also has which of the following? A. Thyroid disease B. Bronchitis C. Heart failure D. Renal impairment (Rationale: sitagliptin, a gliptin, requires cautious use with patients who have renal dysfunction and low creatinine clearance because the kidneys eliminate the drug virtually intact. The primary care provider should prescribe a lower dose for this patient or prescribe a different hypoglycemic drug.) A health care professional is caring for a patient who is about to begin pramlintide (Symlin) therapy to treat type 1 DM. Which of the following instructions should the health care professional include when talking with the patient about using the drug? A. Mix pramlintide with insulin. B. Inject pramlintide before meals. C. Take pramlintide at bedtime. D. Inject pramlintide into the upper arm. (Rationale: the patient should inject pramlintide, an amylin mimetic, 20 min before a meal that contains at least 30g of carbs. Pramlintide supplements the effects of insulin, however, patients should not mix it in the same syringe with insulin. Patients should take pramlintide three times a day. Pramlintide should be injected subQ into the abdomen or thigh, not in the upper arm.) A health care professional is caring for a patient who is about to begin taking pioglitazone (Actos) to treat type 2 DM. The health care professional should explain to the patient the need to monitor which of the following lab tests? (Select all that apply.) A. Thyroid-stimulating hormone (TSH) B. Alanine aminotransferase (ALT) C. LDL D. CBC E. Creatinine clearance (Rationale: pioglitazone can cause liver injury. ALT should be monitored at the start of therapy and every 3-6 months therafter. Tell the patient to report jaundice, dark-colored urine, or abdominal pain. Pioglitazone can also cause elevations in both HDLs and LDLs. Monitor the patient's plasma lipid levels at baseline and periodically throughout drug therapy.) A health care professional administers pramlintide (Symlin) at 0800 to a patient who has type 1 DM. At which of the following times should the patient expect the drug to exert its peak action? A. 0820 B. 0900 C. 1000 D. 1100 (Rationale: pramlintide, an amylin mimetic, peaks 20 min after administration. Monitor the patient for indications of hypoglycemia, such as diaphoresis and tremors.) A health care professional is caring for a patient who is about to begin insulin glargine (Lantus) therapy. The health care professional should recognize the need for additional precautions because the patient also takes which of the following types of drugs? A. Oral contraceptives B. Calcium supplements C. Beta blockers D. Iron supplements (Rationale: patients who take insulin and also take beta blockers are at risk for failing to promptly recognize the symptoms of hypoglycemia because they mask symptoms such as tachycardia and tremors. They also increase hypoglycemic effects.) When talking with a patient who is about to begin repaglanide (Prandin) therapy to treat type 2 DM, the health care professional should include which of the following instructions? A. Do not drink more than 1 L of grapefruit juice per day. B. Carry a high-protein snack at all times. C. Drink 16 oz. of water after taking the drug. D. Use ginseng to reduce the nausea. (Rationale: more than 1 L of grapefruit juice per day can increase the hypoglycemic effects of repaglanide, a meglitinide. The health care professional should tell the patient to avoid drinking large amounts of grapefruit juice.) A health care professional is caring for a patient who is taking pioglitazone (Actos) to treat type 2 DM. The health care professional should monitor for which of the following findings that indicates an adverse effect? A. Joint pain B. Constipation C. Weight gain D. Dilated pupils (Rationale: pioglitazone, a thiazolidinedione, can cause fluid retention. Monitor weight or other indications of fluid retention or HF, including dyspnea, crackles, and wheezing.) A health care professional is caring for a patient who is taking repaglinide (Prandin) 15-30 min before each meal to treat type 2 DM. The patient asks what to do if he skips a meal? Which of the following is the appropriate response? A. Double the dose before the next meal. B. Take half the dose. C. Skip the dose. D. Take the usual dose. (Rationale: to avoid a sudden and serious drop in blood glucose level, the patient should skip the dose of repaglinide, a meglitinide, whenever he skips a meal, and try to avoid skipping meals.) When talking with a patient who is about to begin exenatide (Byetta) therapy to treat type 2 DM, the health care professional should include which of the following instructions? (Select all that apply.) A. Inject the drug subcutaneously. B. Expect the peak effect in 2 hr. C. Use the drug as a supplement to an oral hypoglycemic. D. Inject the drug 1 hr after a meal. E. Discard used pens 10 days after the first use. (Rationale: inject exenatide, an incretin mimetic, subcutaneously. Levels of exenatide peak 2 hours after administration and then decrease gradually, with a 1/2-life of 2.4 hours. Exetinde supplements the action of an oral hypoglycemic, such as a sulfonylurea or metformin. Inject exenatide twice per day up to 60 min prior to morning and evening meals, not after a meal. Prefilled pens may be kept at room temperature for up to 30 days.) Which of the following drugs should a health care professional have available for a patient who is experiencing an insulin overdose? A. Naloxone B. Diphenhydramine C. Acetylcysteine (Acetadote) D. Glucagon (GlucaGen) (Rationale: glucagon, a hyperglycemic that can be given subQ, IM, or IV, treats severe hypoglycemia from an insulin overdose in patients who are unconscious and for whom IV glucose is not readily available. If patient does not respond to glucagon, a glucose solution IV should be administered) A patient who is taking metformin (Glucophage) to treat type 2 DM contacts the health care professional to report muscle pain. The health care professional should suspect which of the following adverse reactions? A. Lactic acidosis B. Anticholinergic effects C. Extrapyramidal symptoms D. Hypophosphatemia (Rationale: metformin, a biguanide, can cause lactic acidosis, which is a life-threatening complication, manifesting as muscle aches, sleepiness, malaise, and hyperventilation. The patient should stop taking the drug and seek medical care immediately.) A patient who is taking glipizide (Glucotrol) to treat type 2 DM contacts the health care professional to report feeling hungry, shaky, and fatigued. The health care professional should tell the patient to do which of the following? A. Drink 16 oz of water. B. Perform a fingerstick blood glucose check. C. Take another glipizide tablet. D. Lie down and rest. (Rationale: glipizide, a sulfonylurea, can cause hypoglycemia, which can manifest as diaphoresis, shakiness, hunger, and fatigue. The health care professional should tell the patient to check her blood glucose level, and if it indicates hypoglycemia, consume a snack of 15-20 g of carbs, retest in 15-20 min, and repeat if her blood glucose level is still low.) A health care professional is talking to a patient about self-injecting Regular insulin (Humulin). The health care professional should tell the patient to rotate injection sites to prevent which of the following? A. Rapid absorption B. Intradermal injection C. Injection pain D. Lipohypertrophy (Rationale: lipohypertrophy is a proliferation of fat at the sites of repeated insulin injections. It affects skin sensitivity and appearance. To prevent it, the patient should rotate injection sites, keeping them at least 1 inch apart, and avoid using the same spot within the same month.) A patient receives NPH and regular insulin every morning. The nurse is verifying that the patient understands that there are two different peak times to be aware of for this insuiln regimen. Why is this an important concept for the nurse to stress? A. The patient needs to plan the next insulin injection around the peak times. B. Additional insulin may be needed at peak times to avoid hyperglycemia. C. It is best to plan exercise or other activities around peak insulin activity. D. The risk for hypoglycemia is greatest around the peak of insulin activity. The patient is schedule to receive 5 units of Humalog and 25 units of NPH (Isophane) insulin prior to breakfast. Which nursing intervention is most appropriate for this patient? A. Make sure the patient's breakfast is available to eat before administering this insulin. B. Offer the patient a high-carb snack in 6 hours. C. Hold the insulin if the blood glucose level is greater than 100 mg/dL. D. Administer the medications in two separate syringes. The nurse is initiating discharge teaching with the newly diagnosed patient with diabetes. Which of the following statements indicates that the patient needs additional teaching? A. "If I am experiencing hypoglycemia, I should drink 1/2 cup of apple juice." B. "My insulin needs may increase when I have an infection." C. "I must draw the NPH insulin first if I am mixing it with regular insulin." D. "If my blood glucose levels are less than 60 mg/dL, I should notify my health care provider." What patient education should the nurse provide to the patient with diabetes who is planning an exercise program? (Select all that apply.) A. Monitor blood glucose levels before and after exercise. B. Eat a complex carb prior to strenuous exercise. C. Exercise may increase insulin needs. D. Withhold insulin prior to engaging in strenuous exercise. E. Take extra insulin prior to exercise. A patient with type 2 diabetes has been nothing by mouth (NPO) since midnight for surgery in the morning. He has been on a combination of oral type 2 antidiabetic drugs. What would be the best action for the nurse to take concerning the administration of his medications? A. Hold all medications as per the NPO order. B. Give him the medications with a sip of water. C. Give him half the original dose. D. Contact the health care provider for further orders. A 63-year-old patient with type 2 diabetes is admitted to the nursing unit with an infected foot ulcer. Despite previous good control on glyburide (Micronase), his blood glucose has been elevated the past several days and he requires sliding-scale insulin. What is the most likely reason for the elevated glucose levels? A. It is a temporary condition related to the stress response with increased glucose release. B. He is converting to a type 1 diabetic. C. The oral antidiabetic drug is no longer working for him. D. Patients with diabetes who are admitted to the hospital are switched to insulin for safety and tighter control. [Show More]
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