NURSING MISC CHAPTER 38 Prep U (GRADED A) Questions and Answers | GUARANTEED PASS.

CHAPTER 38 Prep U Question 1 See full question48s Report this Question A client is admitted to the intensive care unit with diabetic ketoacidosis. The nurse knows that the client will be placed on an intravenous insu ...

CHAPTER 38 Prep U Question 1 See full question48s Report this Question A client is admitted to the intensive care unit with diabetic ketoacidosis. The nurse knows that the client will be placed on an intravenous insulin drip. The only type of insulin that can be administered intravenously is: You Selected: Regular. Correct response: Regular. Explanation: In general, regular insulin, a short-acting insulin, is used with major surgery or surgery requiring general anesthesia. IV administration of insulin is preferred because it provides more predictable absorption than subcutaneous injections. Only regular insulin is administered IV. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Insulin, pp. 634-635. Chapter 38: Agents to Control Blood Glucose Levels - Page 634-635 Add a Note Question 2 See full question1m 18s Report this Question When administering insulin, what would be most appropriate? You Selected: Insert the needle at a 45-degree angle for injection. Correct response: Insert the needle at a 45-degree angle for injection. Explanation: 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. The needle is inserted at a 45-degree angle for subcutaneous administration. Gentle pressure should be applied at the injection site. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Focus on Safe Medication Administration, p. 641. Chapter 38: Agents to Control Blood Glucose Levels - Page 641 Add a Note Question 3 See full question37s Report this Question After teaching a group of students about the various methods for the delivery of insulin, the instructor determines that the teaching was successful when the students identify which method as most commonly used for administration? You Selected: Subcutaneous injection Correct response: Subcutaneous injection Explanation: Subcutaneous injection currently is the most common method for administering insulin. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, BOX 38.5 Insulin Delivery: Past, Present, and Future, p. 640. Chapter 38: Agents to Control Blood Glucose Levels - Page 640 Add a Note Question 4 See full question18s Report this Question After reviewing information about different insulin preparations, a nursing student demonstrates understanding of the information when the student identifies which medication as an example of a long- acting insulin? You Selected: insulin glargine Correct response: insulin glargine Explanation: Insulin glargine is an example of a long-acting insulin. Insulin lispro and insulin aspart are rapid-acting insulin. Isophane insulin suspension is an intermediate-acting insulin. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Prototype Summary: Insulin, p. 642. Chapter 38: Agents to Control Blood Glucose Levels - Page 642 Add a Note Question 5 See full question27s Report this Question A student asks the nursing instructor what insulin has the quickest therapeutic effect once administered. What would be the best response? You Selected: Regular (Humulin R) Correct response: Regular (Humulin R) Explanation: Regular insulin has the quickest onset of 30-60 minutes. PZI and ultralente have an onset of 4-8 hours. NPH has an onset of 60-90 minutes. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Prototype Summary: Insulin, p. 642. Chapter 38: Agents to Control Blood Glucose Levels - Page 642 Add a Note Question 6 See full question16s Report this Question A nurse is presenting an educational event at a local senior citizens' club about diabetes. What would the nurse tell the attendees at the event about diabetes? You Selected: It is a complicated disorder that alters the metabolism of glucose. Correct response: It is a complicated disorder that alters the metabolism of glucose. Explanation: Diabetes is a complicated disorder that alters the metabolism of glucose, fats, and proteins affecting many end organs and causing numerous clinical complications. It is part of the metabolic syndrome, a collection of conditions that predispose to cardiovascular disease. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Agents to Control Blood Glucose Levels, p. 633. Chapter 38: Agents to Control Blood Glucose Levels - Page 633 Add a Note Question 7 See full question51s Report this Question The nurse monitoring a client receiving insulin glulisine (Apidra) notices the client has become confused, diaphoretic, and nauseated. The nurse checks the client's blood glucose and it is 60 mg/dL (3.33 mmol/L). Which can a nurse give to treat a client with a hypoglycemic episode? (Select all that apply.) You Selected: Glucose tablets Orange or other fruit juice Hard candy Correct response: Orange or other fruit juice Glucose tablets Hard candy Explanation: Methods of terminating a hypoglycemic reaction include the administration of one or more of the following: orange or other fruit juice, hard candy or honey, glucose tablets, glucagon, or glucose 10 percent or 50 percent IV. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, PATIENT TEACHING FOR M.J., p. 645. Chapter 38: Agents to Control Blood Glucose Levels - Page 645 Add a Note Question 8 See full question2m 33s Report this Question A nurse is caring for a patient with diabetes mellitus who is receiving an oral antidiabetic drug. Which of following ongoing assessments should the nurse perform when caring for this patient? You Selected: Observe the patient for hypoglycemic episodes. Correct response: Observe the patient for hypoglycemic episodes. Explanation: As the ongoing assessment activity, the nurse should observe the patient for hypoglycemic episodes. Documenting family medical history and assessing the patient's skin for ulcers, cuts, and sores on the body is a pre-administration assessment activity performed by the nurse. Lipodystrophy occurs if the sites of insulin injection are not rotated. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Nursing Considerations for Patients Taking Insulin, pp. 642-643. Chapter 38: Agents to Control Blood Glucose Levels - Page 642-643 Add a Note Question 9 See full question24s Report this Question What type of insulin will most likely be administered intravenously to a client with a blood glucose level over 600 mg/dL (33.33 mmol/L)? You Selected: regular insulin Correct response: regular insulin Explanation: Regular insulin has rapid onset of action and can be given via IV. It is the drug of choice for acute situations, such as diabetic ketoacidosis. Isophane insulin (NPH) is used for long-term insulin therapy. Lente insulin is an intermediate-acting insulin. Ultralente insulin is a long-acting insulin. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Pharmacokinetics, p. 639. Chapter 38: Agents to Control Blood Glucose Levels - Page 639 Add a Note Question 10 See full question28s Report this Question The two major classifications of diabetes are type 1 and type 2. What is a distinguishing characteristic of type 1 diabetes? You Selected: Lifelong exogenous insulin is required. Correct response: Lifelong exogenous insulin is required. Explanation: 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. Insulin cannot be given orally, because it is destroyed by proteolytic enzymes in the GI tract. Although the onset of type 1 diabetes frequently occurs in childhood, it can also occur in adulthood. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Insulin, p. 639. Chapter 38: Agents to Control Blood Glucose Levels - Page 639 Add a Note Question 11 See full question48s Report this Question The nurse has just completed discharge instructions to a client who will be using a pen device to deliver his insulin dose. What statement by the client indicates a need for further instruction? You Selected: "If I forget to take my insulin pen, I will be able to use the one that my wife uses." Correct response: "If I forget to take my insulin pen, I will be able to use the one that my wife uses." Explanation: Insulin pens are client-specific because the needle may be used multiple times and may be contaminated with blood. Also, the pen is prefilled with a specific type of insulin. The client selects the desired units by turning a dial and listening for a locking ring. The insulin dose is determined by the number of clicks heard. It is a useful method for clients who have poor eyesight. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, BOX 38.5 Insulin Delivery: Past, Present, and Future, p. 640. Chapter 38: Agents to Control Blood Glucose Levels - Page 640 Add a Note Question 12 See full question10m 8s Report this Question The nurse is interviewing a client who was diagnosed with type 2 diabetes four months ago. The client does not records glucometer readings but reports no concerns. What laboratory test does the nurse anticipate the health care provider will order for this client? You Selected: HbA1c Correct response: HbA1c Explanation: The nurse anticipates that the glycosylated hemoglobin (HbA1c) will be ordered for this client because it provides an average of the client's blood glucose level for the last three- to four-month period. It will also tell how well controlled the client's blood glucose is. A stat urine for glucose and an FBG in the AM will only indicate the client's current blood glucose level, not how well it is being controlled. An insulin level will not give the information needed to understand the client's control of blood glucose. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Glycosylated hemoglobin, p. 637. Chapter 38: Agents to Control Blood Glucose Levels - Page 637 Add a Note Question 13 See full question1m 3s Report this Question The nurse is educating a client who will be adding an injection of pramlintide to his insulin regimen. What information is most important for the nurse to share with this client to ensure safe medication administration? You Selected: Do not give pramlintide in the same site where insulin is administered. Correct response: Do not give pramlintide in the same site where insulin is administered. Explanation: Clients who take pramlintide should not be injected into the same site where insulin is administered. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Agents to Control Blood Glucose Levels, pp. 651-652. Chapter 38: Agents to Control Blood Glucose Levels - Page 651-652 Add a Note Question 14 See full question6s Report this Question What would alert the nurse to suspect that a client is developing ketoacidosis? You Selected: Fruity breath odor Correct response: Fruity breath odor Explanation: Fruity breath odor would be noted as ketones build up in the system and are excreted through the lungs. Dehydration would be noted as fluid and electrolytes are lost through the kidneys. Blurred vision and hunger would be associated with hypoglycemia. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Hyperglycemia, p. 638. Chapter 38: Agents to Control Blood Glucose Levels - Page 638 Add a Note Question 15 See full question17s Report this Question A nurse is preparing an in-service presentation for a group of staff members on diabetes. Which would the nurse include as the primary delivery system for insulin? You Selected: Subcutaneous injection Correct response: Subcutaneous injection Explanation: Although other delivery systems are available for insulin administration such as the jet injector, insulin pen, and external pump, subcutaneous injection remains the primary delivery system. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Pharmacokinetics, p. 639. Chapter 38: Agents to Control Blood Glucose Levels - Page 639 Add a Note Question 16 See full question56s Report this Question A client, who is 42 years old and newly diagnosed with type 2 diabetes, has attended educational sessions to provide insight into the diagnosis. Which of the client's statements should prompt the nurse to provide further teaching? You Selected: “I'm disappointed, but I take some solace in the fact that I won't ever have to have insulin injections.” Correct response: “I'm disappointed, but I take some solace in the fact that I won't ever have to have insulin injections.” Explanation: Among people with type 2 diabetes, 20% to 30% require exogenous insulin at some point in their lives. Obesity is a major cause, and vigilant treatment can prevent future sequelae. The essence of type 2 diabetes is the pancreas' inability to meet insulin needs. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Insulin, p. 639. Chapter 38: Agents to Control Blood Glucose Levels - Page 639 Add a Note Question 17 See full question21s Report this Question The client is scheduled to get a breakfast tray at 07:00. At what time should the client receive a prescribed dose of insulin lispro? You Selected: 06:45 Correct response: 06:45 Explanation: With short-acting insulins like lispro, aspart, or glulisine, it is important to inject the medication about 15 minutes before eating. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Table 38.2 Drugs in Focus: Insulin, p. 639. Chapter 38: Agents to Control Blood Glucose Levels - Page 639 Add a Note Question 18 See full question28s Report this Question When considering the management of diabetic ketoacidosis (DKA), what type of insulin can be administered intravenously? You Selected: regular Correct response: regular Explanation: Regular insulin (insulin injection) has a rapid onset of action and can be given intravenously. Therefore, it is the insulin of choice during acute situations, such as DKA, severe infection or other illness, and surgical procedures. All the other options are administered subcutaneously. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Table 38.2 Drugs in Focus: Insulin, p. 639. Chapter 38: Agents to Control Blood Glucose Levels - Page 639 Add a Note Question 19 See full question41s Report this Question A client, being evaluated for diabetes, asks how a blood glucose test is used to diagnosis this disease. What is the nurse’s best response? You Selected: "A fasting blood sugar result of 126 mg/dL (6.99 mmol/L) or more on two separate occasions is diagnostic of diabetes." Correct response: "A fasting blood sugar result of 126 mg/dL (6.99 mmol/L) or more on two separate occasions is diagnostic of diabetes." Explanation: A major clinical manifestation of hyperglycemia is fasting blood glucose levels exceeding 126 mg/dL (6.99 mmol/L). A person with a fasting blood glucose level between 100 and 125 mg/dL (5.55 to 6.94 mmol/L) is said to have impaired fasting glucose or prediabetes. The normal hemoglobin A1C level is under 7. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Agents to Control Blood Glucose Levels, p. 633. Chapter 38: Agents to Control Blood Glucose Levels - Page 633 Add a Note Question 20 See full question36s Report this Question After teaching a group of nursing students about antidiabetic drugs, the instructor determines that the teaching was successful when the students identify which as an example of a hormone mimetic? Select all that apply. You Selected: pramlintide sitagliptin exenatide Correct response: sitagliptin exenatide pramlintide Explanation: Sitagliptin, exenatide, and pramlintide are examples of hormone mimetic agents. Acarbose and miglitol are alpha-glucosidase inhibitors. Question 1 See full question38s Report this Question Which would be appropriate to include in teaching a client with type 2 diabetes? You Selected: It is possible with weight loss and exercise to discontinue the use of antidiabetic medication. Correct response: It is possible with weight loss and exercise to discontinue the use of antidiabetic medication. Explanation: Exercise is perhaps the best therapy for the prevention of both type 2 diabetes and the metabolic syndrome. Exercise is an extremely strong hypoglycemic agent. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Diabetes Mellitus, p. 637. Chapter 38: Agents to Control Blood Glucose Levels - Page 637 Add a Note Question 2 See full question1m 36s Report this Question After teaching a class about the various drugs used to control blood glucose, the instructor determines that the teaching was successful when the class identifies what as a biguanide? You Selected: Metformin Correct response: Metformin Explanation: Metformin is classified as a biguanide. Miglitol is an alpha-glucosidase inhibitor. Tolbutamide is a first generation sulfonylurea. Glipizide is a second generation sulfonylurea. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Table 38.3 Drugs in Focus: Other Antidiabetic Agents, p. 647. Chapter 38: Agents to Control Blood Glucose Levels - Page 647 Add a Note Question 3 See full question5m 12s Report this Question A client with diabetes is undergoing testing for glycosylated hemoglobin. The nurse instructs the client that this test measures average blood glucose over what time period? You Selected: the past 3 or 4 months Correct response: the past 3 or 4 months Explanation: Glycosylated hemoglobin measures glucose control over the past 3 to 4 months. When blood glucose levels are high, glucose molecules attach to hemoglobin in the red blood cell. The longer the hyperglycemia lasts, the more glucose binds to the red blood cell and the higher the glycosylated hemoglobin. This binding lasts for the life of the red blood cell (about 4 months) so the other time frames would not be accurate. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Diabetes Mellitus, p. 637. Chapter 38: Agents to Control Blood Glucose Levels - Page 637 Add a Note Question 4 See full question24s Report this Question A nurse is preparing to administer a rapid-acting insulin. Which medication would the nurse most likely administer? You Selected: insulin lispro Correct response: insulin lispro Explanation: Insulin lispro is an example of a rapid-acting insulin. Insulin glargine and insulin detemir are long-acting insulin. Isophane insulin suspension is an intermediate-acting insulin. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Prototype Summary: Insulin, p. 642. Chapter 38: Agents to Control Blood Glucose Levels - Page 642 Add a Note Question 5 See full question22s Report this Question The nurse is conducting a class for newly diagnosed adult diabetic patients. What would the nurse educate the patients about? You Selected: The disease Correct response: The disease Explanation: While it would be important to teach the patients about nutrition, the preservation of intact skin and self-care, adults need extensive education about the disease as well as the drug therapy. Warning signs and symptoms should be stressed repeatedly as the adult learns to juggle insulin needs with exercise, stressors, other drug effects, and diet. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels. Add a Note Question 6 See full question35s Report this Question Which factor would prohibit the administration of glipizide? You Selected: allergy to sulfonamides Correct response: allergy to sulfonamides Explanation: Sulfonylureas are contraindicated in clients with hypersensitivity to them, with severe renal or hepatic impairment, and who are pregnant. A diagnosis of hypertension does not cause contraindication of sulfonylureas. The client should consume carbohydrates in association with the oral hypoglycemic agent. An increase in alkaline phosphatase does not result in the contraindication of glipizide. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Contraindications and Cautions, p. 649. Chapter 38: Agents to Control Blood Glucose Levels - Page 649 Add a Note Question 7 See full question45s Report this Question A female client visits the health care provider’s office after routine labs are drawn. The nurse notes that her A1C is 9. How does the nurse interpret this finding? You Selected: Client’s average blood glucose is above normal. Correct response: Client’s average blood glucose is above normal. Explanation: The American Diabetes Association (ADA) suggests a target A1C of less than 7%. A1C should be measured every 3 to 6 months. An A1C of 9 indicates that the client’s average blood glucose is consistently above normal. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Glycosylated hemoglobin, p. 637. Chapter 38: Agents to Control Blood Glucose Levels - Page 637 Add a Note Question 8 See full question1m 40s Report this Question The nurse admitted a 4-year-old child with type 1 diabetes mellitus. The nurse educates the parents that hypoglycemia can occur as an adverse effect of insulin. The nurse helps the parents to understand that in young children, hypoglycemia may manifest as what signs or symptoms? (Select all that apply.) You Selected: Lethargy Irritability Impaired mental functioning Correct response: Irritability Impaired mental functioning Lethargy Explanation: In young children, hypoglycemia may be manifested by changes in behavior, including severe hunger, irritability, and lethargy. In addition, mental functioning may be impaired in all age groups, even with mild hypoglycemia. Anytime hypoglycemia is suspected, blood glucose should be tested. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Hyperglycemia, p. 638. Chapter 38: Agents to Control Blood Glucose Levels - Page 638 Add a Note Question 9 See full question31s Report this Question What statement would be appropriately included in the teaching concerning type 2 diabetes? You Selected: “Regular exercise makes your body better able to use the insulin it produces.” Correct response: “Regular exercise makes your body better able to use the insulin it produces.” Explanation: People who need less than 0.5 units/kg/d may produce some endogenous insulin, or their tissues may be more responsive to insulin because of exercise and good physical conditioning. Exercise is an extremely strong hypoglycemic agent. Diabetics need to check their blood sugar level regardless of whether they are or are not prescribed insulin. The need for insulin injections is determined by the function of the pancreas and its ability to produce sufficient quantities of insulin. It is not correct to assume diet is the only factor in this process. Alcohol should be avoided, and the dosage of oral antidiabetic medication should not be altered without guidance from a health care provider. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Glycosylated hemoglobin, p. 637. Chapter 38: Agents to Control Blood Glucose Levels - Page 637 Add a Note Question 10 See full question1m 8s Report this Question A client who began treatment for type 2 diabetes 8 months ago is now meeting with a diabetic nurse for a scheduled follow-up. How can the nurse best assess the client’s glycemic control since beginning treatment? You Selected: Assess the most recent hemoglobin A1C levels. Correct response: Assess the most recent hemoglobin A1C levels. Explanation: Health care providers also look at the glycosylated hemoglobin (hemoglobin A1C) levels to assess the effectiveness of treatment. Because glucose stays attached to hemoglobin for the life of the red blood cell, which is about 120 days, the hemoglobin A1C level reflects the average blood glucose level over the past 3 months. Reviewing blood glucose readings, measuring the client’s random blood glucose, and dialoguing with the client are all therapeutic strategies, but hemoglobin A1C is most accurate. Question 1 See full question1m 22s Report this Question Sometimes there is a confusion between the names of drugs. What two insulin products are most at risk of being confused? You Selected: Lente insulin and lantus insulin Correct response: Lantus insulin and lente insulin Explanation: Name confusion has occurred between lantus insulin and lente insulin. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Focus on Safe Medication Administration, p. 639. Chapter 38: Agents to Control Blood Glucose Levels - Page 639 Add a Note Question 2 See full question28s Report this Question A nurse at a health care facility is assigned to administer insulin to the patient. Which intervention should the nurse perform before administering each insulin dose? You Selected: Inspect the previous injection site for inflammation. Correct response: Inspect the previous injection site for inflammation. Explanation: The nurse should check the previous injection site before administering each insulin dose. The injection sites should be rotated to prevent lipodystrophy. Prefilled syringes should not be kept horizontally; they should be kept in a vertical or oblique position to avoid plugging the needle. The nurse checks for symptoms of myalgia or malaise when administration of metformin leads to lactic acidosis. Insulin should be kept at room temperature for administration. Insulin is refrigerated if it needs to be stored for up to three months for later use. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Pharmacokinetics, p. 639. Chapter 38: Agents to Control Blood Glucose Levels - Page 639 Add a Note Question 3 See full question36s Report this Question Insulin binds with and activates receptors on cell membranes. Once insulin-receptor binding occurs, the membranes become highly permeable to glucose. Which action does this enable? You Selected: Entry of glucose into the cells Correct response: Entry of glucose into the cells Explanation: After insulin–receptor binding occurs, cell membranes become highly permeable to glucose and allow rapid entry of glucose into the cells. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Glycosylated hemoglobin, p. 637. Chapter 38: Agents to Control Blood Glucose Levels - Page 637 Add a Note Question 4 See full question6s Report this Question Which would a nurse identify as an example of a sulfonylurea? You Selected: Glyburide Correct response: Glyburide Explanation: Glyburide is an example of a sulfonylurea. Metformin is classified as a biguanide. Acarbose and miglitol are alpha-glucosidase inhibitors. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Table 38.3 Drugs in Focus: Other Antidiabetic Agents, p. 646. Chapter 38: Agents to Control Blood Glucose Levels - Page 646 Add a Note Question 5 See full question12s Report this Question Which would be least appropriate when administering insulin by subcutaneous injection? You Selected: Massaging the site after removing the needle Correct response: Massaging the site after removing the needle Explanation: Gentle pressure should be applied to the injection after the needle is withdrawn. Massaging could contribute to erratic or unpredictable absorption. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels. Add a Note Question 6 See full question49s Report this Question A client newly diagnosed with type 1 diabetes asks the nurse why the client cannot just take a pill. The nurse would incorporate what knowledge when responding to this client? You Selected: Insulin is needed because the beta cells of the pancreas are no longer functioning. Correct response: Insulin is needed because the beta cells of the pancreas are no longer functioning. Explanation: Insulin is needed in type 1 diabetes because the beta cells of the pancreas are no longer functioning. With type 2 diabetes, insulin is produced, but perhaps not enough to maintain glucose control or the insulin receptors are not sensitive enough to insulin. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Insulin, p. 634. Chapter 38: Agents to Control Blood Glucose Levels - Page 634 Add a Note Question 7 See full question35s Report this Question When describing the effects of incretins on blood glucose control to a group of students, which would an instructor include? You Selected: Increases insulin release Correct response: Increases insulin release Explanation: Incretins increase insulin release, decrease glucagon release, slow GI emptying, and stimulate the satiety center. Growth hormone increases protein building. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, BOX 38.2 Glucose Control Mechanisms, p. 635. Chapter 38: Agents to Control Blood Glucose Levels - Page 635 Add a Note Question 8 See full question2m 7s Report this Question A client has been prescribed glucagon for the management of hypoglycemia. Which nursing interventions should the nurse be prepared to provide this client for the management of possible adverse effects? Select all that apply. You Selected: Administration of a prescribed suppository for the management of nausea Implementation of aspiration precautions Correct response: Administration of a prescribed suppository for the management of nausea Implementation of aspiration precautions Ready access to supplemental oxygen Explanation: Glucagon is associated with hypotension, hypertension, nausea, vomiting, respiratory distress with hypersensitivity reactions, and hypokalemia with overdose. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Table 38.1 Signs and Symptoms of Hypoglycemia and Hyperglycemia, p. 638. Chapter 38: Agents to Control Blood Glucose Levels - Page 638 Add a Note Question 9 See full question24s Report this Question Heavy intake of which herb should be avoided by a client who is prescribed an antidiabetic medication? You Selected: garlic Correct response: garlic Explanation: Garlic has been known to cause hypoglycemia when taken with antidiabetic medications. Anise, basil, and oregano are not noted to carry this risk. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Box 38.6 Focus on Herbal and Alternative Therapies, p. 642. Chapter 38: Agents to Control Blood Glucose Levels - Page 642 Add a Note Question 10 See full question29s Report this Question Rosiglitazone is being considered for the treatment of diabetes in an adult male client. Before the initiation of rosiglitazone therapy, the nurse should review what laboratory work recently drawn? You Selected: liver enzymes Correct response: liver enzymes Explanation: Rosiglitazone has been associated with hepatotoxicity and requires monitoring of liver enzymes. Liver function tests (e.g., serum aminotransferase enzymes) should be checked before starting therapy and every 2 months for 1 year, then periodically. Platelets, D-dimer, and tests of renal function are less significant to the safety and efficacy of treatment. Question 1 See full question17s Report this Question A client is prescribed sitagliptin. The nurse would expect to administer this drug by which route? You Selected: Oral Correct response: Oral Explanation: Sitagliptin is administered orally. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Table 38.3 Drugs in Focus: Other Antidiabetic Agents, p. 647. Chapter 38: Agents to Control Blood Glucose Levels - Page 647 Add a Note Question 2 See full question36s Report this Question A patient with type 1 diabetes has come to the clinic for a routine follow-up appointment. While assessing the patient's skin, the nurse observes brown spots on his lower legs. What might these spots indicate? You Selected: Widespread changes in the blood vessels Correct response: Widespread changes in the blood vessels Explanation: Diabetes can cause significant vascular problems. Brown spots on the lower legs of a diabetic patient are caused by small hemorrhages into the skin and may indicate widespread changes in the blood vessels. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels. Add a Note Question 3 See full question15s Report this Question The nurse is preparing to administer a mixture of 12 units regular insulin and 45 units NPH insulin to a client with a blood sugar of 378 mg/dL. After the nurse draws the medication into the syringe, what is the nurse's next action? You Selected: Check the dosage with another nurse. Correct response: Check the dosage with another nurse. Explanation: After preparing the syringe with insulin, the nurse should then have the medication and dosage checked by a second nurse to make sure that it is correct. It is not necessary to recheck the client's blood sugar again. It is important to know when the client will be eating again; make sure that it is within the next 30 minutes. However, this is not the nurse's next step. Then the nurse will administer the insulin to the client. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, NURSING CARE GUIDE FOR M.J.: TYPE 1 DIABETES MELLITUS, p. 645. Chapter 38: Agents to Control Blood Glucose Levels - Page 645 Add a Note Question 4 See full question13s Report this Question Before administering a prescribed 20 units of NPH insulin to a client, the nurse should implement which intervention? You Selected: Have a colleague confirm the dosage. Correct response: Have a colleague confirm the dosage. Explanation: Before administering insulin, client safety requires that two nurses always check the dosage. Assessing the client's understanding of the disease may or may not be appropriate or necessary at this time. Injection sites are not massaged before administration. It is not necessary to assess urine for the presence of glucose. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Pharmacokinetics, p. 639. Chapter 38: Agents to Control Blood Glucose Levels - Page 639 Add a Note Question 5 See full question13s Report this Question A client prescribed metformin is scheduled to undergo diagnostic testing with the administration of parenteral radiographic contrast media containing iodine. What fact should direct the nurse’s plan of care for this client? You Selected: Metformin should be discontinued at least 48 hours before and after diagnostic tests that use contrast medias. Correct response: Metformin should be discontinued at least 48 hours before and after diagnostic tests that use contrast medias. Explanation: Metformin should be discontinued at least 48 hours before diagnostic tests are performed with these materials and should not be resumed for at least 48 hours after the tests are done and tests indicate renal function is normal. By altering the metformin therapy, none of the other options are required. Question 1 See full question26s Report this Question After reviewing information about different insulin preparations, a nursing student demonstrates understanding of the information when the student identifies which medication as an example of a long- acting insulin? You Selected: insulin glargine Correct response: insulin glargine Explanation: Insulin glargine is an example of a long-acting insulin. Insulin lispro and insulin aspart are rapid-acting insulin. Isophane insulin suspension is an intermediate-acting insulin. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Prototype Summary: Insulin, p. 642. Chapter 38: Agents to Control Blood Glucose Levels - Page 642 Add a Note Question 2 See full question10s Report this Question Which is the best indicator of overall diabetic control? You Selected: Glycosylated hemoglobin levels Correct response: Glycosylated hemoglobin levels Explanation: The glycosylated hemoglobin indicates glucose bound to hemoglobin in red blood cells (RBCs) when RBCs are exposed to hyperglycemia. The binding is irreversible and lasts for the lifespan of RBCs (approximately 120 days). The test reflects the average blood sugar level during the previous 2 to 3 months. The goal is usually less than 7% (blood level 0.07). The range for people without diabetes is approximately 4% to 6% (blood level 0.04 to 0.06). Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Glycosylated hemoglobin, p. 637. Chapter 38: Agents to Control Blood Glucose Levels - Page 637 Add a Note Question 3 See full question39s Report this Question A patient at a health care facility has been prescribed diazoxide for hypoglycemia due to hyperinsulinism. What adverse reactions to the drug should the nurse monitor for in the patient? You Selected: Tachycardia Correct response: Tachycardia Explanation: The nurse should monitor for tachycardia, congestive heart failure, sodium and fluid retention, hyperglycemia, and glycosuria as the adverse reactions in the patient receiving diazoxide drug therapy. Myalgia, fatigue, and headache are the adverse reactions observed in patients undergoing pioglitazone HCl drug therapy. Flatulence is one of the adverse reactions found in patients receiving metformin drug therapy. Epigastric discomfort is one of the adverse reactions observed in patients receiving acetohexamide drugs. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Table 38.1 Signs and Symptoms of Hypoglycemia and Hyperglycemia, p. 638. Chapter 38: Agents to Control Blood Glucose Levels - Page 638 Add a Note Question 4 See full question16s Report this Question A nurse is caring for a patient who has developed a hypoglycemic reaction. Which intervention should the nurse perform if swallowing and gag reflexes are present in the patient? You Selected: Give oral fluids or candy. Correct response: Give oral fluids or candy. Explanation: The nurse should administer oral fluids or candy to the hypoglycemic patient with swallowing and gag reflexes. If the patient is unconscious the nurse should administer glucose or glucagon parenterally. The nurse should administer insulin through an insulin pump to special categories of diabetic patients, such as pregnant women with diabetes and renal transplantation. Oral antidiabetic drugs are administered to patients with type 2 diabetes. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, PATIENT TEACHING FOR M.J., p. 645. Chapter 38: Agents to Control Blood Glucose Levels - Page 645 Add a Note Question 5 See full question32s Report this Question Which condition must be met in order for glyburide treatment to be effective? You Selected: The client must have functioning pancreatic beta cells. Correct response: The client must have functioning pancreatic beta cells. Explanation: Because glyburide stimulates pancreatic beta cells to produce more insulin, it is effective only when functioning pancreatic beta cells are present. The presence of normal blood glucose levels would render the medication unnecessary. Self-administration is common but not absolutely necessary. Question 1 See full question18s Report this Question A client receives a dose of insulin lispro at 8 AM. The nurse would be alert for signs and symptoms of hypoglycemia at which time? You Selected: Between 8:30 AM and 9:30 AM Correct response: Between 8:30 AM and 9:30 AM Explanation: With insulin lispro, peak effects would occur in 30 to 90 minutes or between 8:30 AM and 9:30 AM. Regular insulin peaks in 2 to 4 hours, so the nurse would be alert for signs and symptoms of hypoglycemia at this time, which would be between 10 AM and 12 noon. With insulin detemir, peak effects would occur in 6 to 8 hours, or between 2 PM and 4 PM. With NPH insulin, peak effects would occur in 4 to 12 hours, or between 12 noon and 8 PM. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Hypoglycemia, p. 638. Chapter 38: Agents to Control Blood Glucose Levels - Page 638 Add a Note Question 2 See full question21s Report this Question A man is brought to the emergency department. He is nonresponsive, and his blood glucose level is 32 mg/dL. Which would the nurse expect to be ordered? You Selected: Glucagon Correct response: Glucagon Explanation: The client is significantly hypoglycemic and needs emergency treatment. Glucagon would be the agent of choice to raise the client’s glucose level because it can be given intravenously and has an onset of approximately 1 minute. Diazoxide can be used to elevate blood glucose levels, but it must be given orally. Lispro and regular insulin would be used to treat hyperglycemia. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Glucagon, p. 635. Chapter 38: Agents to Control Blood Glucose Levels - Page 635 Add a Note Question 3 See full question28s Report this Question The nurse is providing care for several clients who have diabetes. Which client should the nurse monitor most closely for signs and symptoms of hypoglycemia? You Selected: a client who received 12 units of Humulin R 45 minutes ago Correct response: a client who received 12 units of Humulin R 45 minutes ago Explanation: Administration of regular insulin will create a greater risk for hypoglycemia than metformin, which is used in the treatment of type 2 diabetes. A blood glucose level of 150 mg/dL is nominally elevated, and creates no particular risk for “rebound” hypoglycemia. Clients whose diabetes has been recently diagnosed must be monitored closely, but this does not mean that the client faces a particular risk for hypoglycemia. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Hypoglycemia, p. 638. Chapter 38: Agents to Control Blood Glucose Levels - Page 638 Add a Note Question 4 See full question36s Report this Question What is the expected action of sitagliptin on type 2 diabetes? You Selected: It slows the rate of inactivation of the incretin hormones. Correct response: It slows the rate of inactivation of the incretin hormones. Explanation: Sitagliptin minimizes the rate of inactivation of the incretin hormones to increase hormone levels and prolong their activity. Sitagliptin does not block the S phase of the cell cycle. Sitagliptin is not a synthetically prepared monosodium salt nor does it inhibit hydrogen, potassium, and ATPase. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Prototype Summary: Sitagliptin, p. 653. Chapter 38: Agents to Control Blood Glucose Levels - Page 653 Add a Note Question 5 See full question1m 3s Report this Question A hospital client with a diagnosis of type 1 diabetes is prescribed Humulin R on a sliding scale. Based on the client's blood glucose reading, the nurse administered 8 units of insulin at 07:45. The nurse should consequently check the client's blood glucose level at what time to monitor peak effectiveness of the medication? You Selected: between 09:45 and 10:45 Correct response: between 09:45 and 10:45 Explanation: Humulin R peaks between 2 and 3 hours after administration, so monitoring should occur between 09:45 and 10:45.