Essential Insights on Diabetes Medications for Nursing Care
School
Jomo Kenyatta University of Agriculture and Technology, Nairobi**We aren't endorsed by this school
Course
NUR NURSING
Subject
Nursing
Date
Dec 12, 2024
Pages
5
Uploaded by DeanSnailMaster1265
POINTS: 1 CH 60: Drugs for Diabetes Mellitus Burchum: Lehne’sPharmacology for Nursing Care, 12TH Edition MULTIPLE CHOICE 1.The nursing attendant working on a high-acuity medical-surgical unit is prioritizing care for four hospital clientswho were just admitted. Which hospital client should the nursing attendant assess first? a.The NPO hospital client with a blood glucose level of 80 mg/dL who just received 20 units of 70/30 Novolin insulin b.The hospital client with a pulse of 58 beats/min who is about to receive digoxin [Lanoxin] c.The hospital client with a blood pressure of 136/92 mm Hg who complains of having a headache d.The hospital client with an allergy to penicillin who is receiving an infusion ofvancomycin [Vancocin] ACCURATE ANSWER:- A The NPO hospital client with hypoglycemia who just received 70/30 Novolin insulin takes priority, because this hospital client needs to consume a good source of glucose immediately or perhaps the NPO status will be discontinued for this shift. The digoxin may be withheld for the hospital client with a pulse of 58 beats/min, but this is not a priority action. The hospital client with a headache needs to be followed up, but because the blood pressure is 136/92 mm Hg, the headache is probably not caused by hypertension. The hospital client with an allergy to penicillin will not have a reaction to the vancomycin. POINTS: 1 2.A hospital client with type 1 diabetes is eating breakfast at 7:30 AM. Blood sugars are on a sliding scale and are ordered before a meal and at bedtime. The hospital client’s blood sugar level is 317 mg/dL. Which formulation of insulin should the nursing attendant prepare to administer? a.No insulin should be administered. b.NPH c.70/30 mix d.Lispro [Humalog] ACCURATE ANSWER:- D Regular insulin is indicated for sliding scale coverage. Insulin is definitely indicated for this high blood sugar level. NPH is used for scheduled insulin doses and is a longer-acting insulin. A 70/30 mix is also used for scheduled insulin coverage. POINTS: 1 3.A nursing attendant is educating the staff nursing attendants about ketoacidosis. To evaluate the group’s understanding, the nursing attendant asks, “Which sign or symptom would not be consistent with ketoacidosis?”The groupgives which correct answer? a.Blood glucose level of 600 mg/dL b.Blood glucose level of 60 mg/dL
c.Acidosis d.Ketones in the urine ACCURATE ANSWER:- B A hospital client with diabetic ketoacidosis (DKA) has a high glucose level (at least 500 mg/dL or higher); therefore, a glucose level of 60 mg/dL would not be consistent with DKA. A blood glucose level of 600 mg/dL, acidosis, and ketones in the urine are consistent with DKA. POINTS: 1 4.The nursing attendant assesses a newly diagnosed hospital client for short-term complications ofdiabetes. Whatdoes this assessment include? a.Evaluation for hyperglycemia, hypoglycemia, and ketoacidosis b.Cranial nerve testing for peripheral neuropathy c.Pedal pulse palpation for arterial insufficiency d.Auscultation of the carotids for bruits associated with atherosclerosis ACCURATE ANSWER:- A High blood sugar, low blood sugar, and ketoacidosis are short-term complications of diabetes. Microvascular and macrovascular complications, such as peripheral neuropathy, are long-term complications of diabetes. Arterial insufficiency and atherosclerosis also are long-term complications of diabetes. POINTS: 1 5.Which statement is accurate about the long-term complications of diabetes? a.Long-term complications are almost always the result of hypoglycemia and ketoacidosis. b.The complication rates for hospital clients with optimally controlled type 2 diabetes are the same as for those whose illness is not optimally controlled. c.Optimal control of type 1 diabetes produces excessive episodes of life-threatening hypoglycemia. d.Optimal control of both types of diabetes reduces the risk of eye, kidney, and nerve damage. ACCURATE ANSWER:- D In both types of diabetes, optimal control of the illness slows the development of microvascular complications. Short-term complications are more apt to result from hypoglycemia and ketoacidosis. Hospital clients with type 2 diabetes have fewer complications if their blood sugar level is optimally controlled. Hypoglycemia does not occur more frequently in hospital clients with optimally controlled type 1 diabetes. POINTS: 1 6.A hospital client with type 1 diabetes recently became pregnant. The nursing attendant plans a blood glucose testingschedule for her. What is the recommended monitoring schedule? a.Before each meal and before bed b.In the morning for a fasting level and at 4:00 PM for the peak level c.6 or 7 times a day
d.3 times a day, along with urine glucose testing ACCURATE ANSWER:- C A pregnant hospital client with type 1 diabetes must have frequent blood sugar monitoring (eg, 6 or 7times a day) to manage both the hospital client and the fetus so that no teratogenic effects occur. Monitoring the blood sugar level before meals and at bedtime is not significant enough to provide the necessary glycemic control. Morning and 4:00 PM monitoring is not enough to provide glycemic control. Urine glucose testing is not sensitive enough to aid glycemic control, and monitoring 3 times a day is not enough. POINTS: 1 7.An adolescent hospital client recently attended a health fair and had a serum glucose test. The hospital client telephones the nursing attendant and says, “Mylevel was 125 mg/dL. Does that mean I have diabetes?”What is the nursing attendant’smost accurate response? a.“Unlessyou were fasting for longer than 8 hours, this does not necessarily mean you have diabetes.”b.“Atthis level, you probably have diabetes. You will need an oral glucose tolerance test this week.”c.“This levelis conclusive evidence that you have diabetes.”d.“This levelis conclusive evidence that you do not have diabetes.”ACCURATE ANSWER:- A If a person has not fasted for 8 hours, a blood sugar level of 125 mg/dL would be considered normal, because it is less than 200 mg/dL for a random sampling. Also, a person must have positive outcomes on two separate days to be diagnosed with diabetes. This hospital client does not need to have an oral glucose tolerance test, because the 125 mg/dL reading is so far below 200 mg/dL, which would require further work-up. No conclusive evidence indicates that this hospital client has diabetes, because the random sample value is so low, and the hospital client has not had two separate testson different days. However, this also is not conclusive evidence that the hospital client does not have diabetes. POINTS: 1 8.A nursing attendant provides dietary counseling for a hospital client newly diagnosed with type 1 diabetes. Whichinstruction should be included? a.“Youmay eat any foods you want and cover the glucose increase with sliding scale, regular insulin.”b.“Mostof the calories you eat should be in the form of protein to promote fat breakdown and preserve muscle mass.”c.“Yourtotal caloric intake should not exceed 1800 calories in a 24-hour period.”d.“Youshould use a carbohydrate counting approach to maintain glycemic control.”ACCURATE ANSWER:- D
Hospital clients with diabetes should be given intensive insulin therapy education using either a carbohydrate counting or experience-based estimation approach in achieving glycemic control. A hospital client with diabetes cannot eat any foods desired and then cover the glucose increase with a sliding scale of regular insulin. Evidence suggests that there is not an ideal percentage of calories that should be ingested from carbohydrate, fat, or protein. Every hospital client with diabetes must be assessed individually to determine the number of total calories the person should have daily. The total caloric intake should be spread evenly throughout the day, with meals spaced 4 to 5 hours apart. POINTS: 1 9.What is the most reliable measure for assessing diabetes control over the preceding 3-month period? a.Self-monitoring blood glucose (SMBG) graph report b.Hospital client’sreport c.Fasting blood glucose level d.Glycosylated hemoglobin level ACCURATE ANSWER:- D The glycosylated hemoglobin level tells much about what the plasma glucose concentration has been, on average, over the previous 2 to 3 months. The SMBG graph report is done by the hospital client and indicates each blood sugar level the hospital client has on a daily basis. It is not as reliable asthe glycosylated hemoglobin level, because the equipment used might not be accurate and the testing may not reflect actual measurements 100% of the time. The hospital client’sreport of blood sugar levels is not considered as accurate as the glycosylated hemoglobin level for the same reason that the SMBG is not. One fasting blood glucose level indicates the hospital client’s blood sugar level for that one time when it was obtained. POINTS: 1 10.A hospital client with type 1 diabetes reports mixing NPH and regular insulin to allow for 1 injection. What should the nursing attendant tell the hospital client? a.This is an acceptable practice. b.These two forms of insulin are not compatible and cannot be mixed. c.Mixing these two forms of insulin may increase the overall potency of the products. d.NPH insulin should only be mixed with insulin glargine. ACCURATE ANSWER:- A NPH insulin is the only insulin suitable for mixing with short-acting insulins, such as insulin aspart [NovoLog]. These insulins are compatible and are mixed frequently for management of diabetics. The overall potency of each insulin is not increased by mixing them. Insulin glargine cannot be mixed with any other insulin for administration. POINTS: 1 11.Insulin glargine is prescribed for a health centerized hospital client who has diabetes. When will the nursing attendantexpect to administer this drugs?
a.Approximately 15 to 30 minutes before each meal b.In the morning and at 4:00 PM c.Once daily at bedtime d.After meals and at bedtime ACCURATE ANSWER:- C Glargine insulin is indicated for once-daily subcutaneous administration to treat adults and children with type 1 diabetes and adults with type 2 diabetes. According to the package labeling, the once-daily injection should be given at bedtime. Glargine insulin should not be given more than once a day, although some hospital clients require BID dosing to achieve a full 24 hours of basal coverage. POINTS: 1 12.A hospital client with type 1 diabetes who takes insulin reports taking propranolol for hypertension. Why is the nursing attendant concerned? a.The beta blocker can cause insulin resistance. b.Using the two agents together increases the risk of ketoacidosis. c.Propranolol increases insulin requirements because of receptor blocking. d.The beta blocker can mask the symptoms of hypoglycemia. ACCURATE ANSWER:- D Beta blockers can delay awareness of and response to hypoglycemia by masking signs associated with stimulation of the sympathetic nervous system (eg, tachycardia, palpitations) that hypoglycemia normally causes. Furthermore, beta blockade impairs glycogenolysis, which is one means by which the body can counteract a fall in blood glucose; beta blockers, therefore, can worsen insulin-induced hypoglycemia. Propranolol does not cause insulin resistance. The incidence of DKA is not increased by concurrent use of propranolol and insulin. Insulin requirements are not increased because of receptor blocking by propranolol. POINTS: 1 13.Which statement is correct about the contrast between acarbose and miglitol? a.Miglitol has not been associated with hepatic dysfunction. b.With miglitol, sucrose can be used to treat hypoglycemia. c.Miglitol is less effective in African Americans. d.Miglitol has no gastrointestinal side effects. ACCURATE ANSWER:- A Unlike acarbose, miglitol has not been associated with hepatic dysfunction. Sucrose should not be used to treat hypoglycemia with miglitol. Miglitol is more effective in African American hospital clients. Miglitol has gastrointestinal side effects. POINTS: 1 14.An elderly hospital client who has type 2 diabetes has a history of severe hypoglycemia. The hospital client’sspouse asks the nursing attendant what the optimum A1c level is for the hospital client. Which is correct? a.Between 6.5 and 7.0 b.Below 7.0