Chapter 11: Antidiabetic Medications Turner: Mulholland’s The Nurse, The Math, The Meds, 4th Edition abirb.com/test MULTIPLE CHOICE abirb.com/test 1. A test that determines the average blood glucose level over the past 2 to 3 months is called: a. HbA1c (glycosylated hemoglobin). b. fasting blood glucose (FBS). c. postprandial glucose test. abirb.com/test d. BGM. ANS: A abirb.com/test 2. What does U 100 on an insulin label mean exactly? a. 100 units of total contents in the bottle b. 100 units per mL c. 100 units is the usual dose d. 100 units per hr is recommended ANS: B abirb.com/test abirb.com/test 3. If a patient is having a hypoglycemic episode, which of the following choices would be best to give first if the patient is able to swallow? a. Diet cola b. Coffee (caffeine) c. Orange juice d. An antidiabetic pill abirb.com/test abirb.com/test ANS: C ESSAY abirb.com/test 1. a. What are the three main classifications of insulin activity (onset and/or duration)? b. Does insulin elevate or lower blood glucose levels? abirb.com/test abirb.com/test abirb.com/test ANS: a. Short-/rapid-; intermediate-; long-acting insulin b. Lowers blood glucose 2. Ordered: NovoLog insulin 8 units subcut ac tid abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test a. Mark the dose on the syringe. abirb.com/test abirb.com/test b. Is this a rapid-, intermediate-, or long-acting insulin? c. What does U 100 mean? abirb.com/test ANS: a. abirb.com/test abirb.com/test b. Rapid c. 100 units per mL abirb.com/test 3. Ordered: insulin glargine 28 units subcut at bedtime daily abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test a. What is the concentration in units per milliliter? b. Mark the dose on the syringe. abirb.com/test abirb.com/test c. Is this a rapid-, intermediate-, or long-acting insulin? abirb.com/test d. What is the major difference between insulin glargine and other insulins? ANS: abirb.com/test a. 100 units per mL b. abirb.com/test abirb.com/test c. Long-acting d. Insulin glargine does not have a peak. It can be given any time of day as long as it is the abirb.com/test same time each day. 4. Ordered: NovoLog 6 units subcut tid ac daily abirb.com/test abirb.com/test abirb.com/test abirb.com/test a. Mark the dose on the syringe. abirb.com/test abirb.com/test b. Is this a rapid-, intermediate-, or long-acting insulin? c. Which types of patients particularly benefit from use of this type of syringe? abirb.com/test ANS: a. abirb.com/test abirb.com/test b. Rapid c. Patients with impaired vision benefit from using this syringe. Doses can be read more easily. abirb.com/test 5. Ordered: an insulin mix—Humulin R 4 units, subcut AM and PM; Humulin N 26 units, 30 minutes before meals a. Is Humulin N a rapid-, intermediate-, or long-acting insulin? abirb.com/test b. Which type of insulin should the nurse withdraw first for the mix: Humulin R or Humulin N? State the reason for this decision. c. Mark the total dose. Indicate the Humulin R and Humulin N doses with arrows. abirb.com/test abirb.com/test ANS: abirb.com/test a. Intermediate b. The short-/rapid-acting Humulin R must be withdrawn first to protect it from contamination with a longer acting insulin. Contamination could change the action of the regular insulin. c. First arrow shows 4 units drawn to Humulin R, total dose shown with second arrow at 30 abirb.com/test units when Humulin N dose is added. abirb.com/test abirb.com/test abirb.com/test abirb.com/test 6. Ordered: Novolin R subcut per sliding scale q6h, for a patient receiving total parenteral nutrition Blood Glucose (mg per dL) Insulin (units) abirb.com/test 70-150 0 151-200 4 201-250 6 abirb.com/test 251-300 10 a. The patient’s blood glucose level is 240 mg per dL. How many units should the nurse administer? b. Why must U be written out as units in medical records?abirb.com/test ANS: a. 6 units b. U can be misread as 0 (zero) abirb.com/test 7. Ordered: Humulin R 6 Units per hr IV infusion Recheck the blood glucose level in 1 hour and notify the prescriber’s office. abirb.com/test Available: 100 units Humulin R in 100 mL NS How many milliliters per hour will the nurse set on the infusion pump? a. Estimated flow rate: abirb.com/test b. DA equation: c. Evaluation: d. Why should diet beverages not be given if hypoglycemic reaction is suspected or occurring? abirb.com/test ANS: a. Estimate: 6 mL per hour b. abirb.com/test c. Equation is balanced. Only mL per hour remains. Note: If the concentration is 1:1, such as 100 mL, mL per hour will equal the ordered units per hour. abirb.com/test d. Dextrose is needed to elevate blood glucose levels. Diet beverages contain dextrose substitutes, which do not affect blood glucose promptly or adequately. 8. Ordered: Humulin Regular insulin infusion IV at 4 units per hr abirb.com/test Available: 50 units Humulin Regular insulin in 100 mL of NS How many milliliters per hour should the nurse set on the infusion pump? abirb.com/test a. Estimated flow rate: b. DA equation: c. Evaluation: abirb.com/test d. What are the only insulin products that may be administered intravenously? abirb.com/test ANS: a. Estimate: The concentration is or 2 mL for each unit; therefore, the flow rate abirb.com/test estimate is 8 mL per hour. b. abirb.com/test c. Equation is balanced. Estimate supports answer. Only mL per hour remains. d. Regular insulin products and insulin lispro (Humalog) may be administered intravenously. Intermediate-, long-acting, mixed insulins, and insulin aspart (NovaLog) cannot be abirb.com/test administered intravenously due to additives. 9. Ordered: insulin infusion, Humulin R 7 units per hr Infusing: insulin Humulin R infusion at 10 mL per hr abirb.com/test Available: 100 units Humulin R in 100 mL NS How many units of insulin are infusing? a. Estimate: abirb.com/test b. DA equation: c. Evaluation: How many milliliters per hour will deliver the ordered flow rate? d. Estimate: abirb.com/test e. DA equation: f. Evaluation: g. Decision: abirb.com/test ANS: a. 10 units (the concentration is 1 unit: 1 mL) b. abirb.com/test c. Equation is balanced. Estimate supports answer. Only units per hour remain. d. Estimate: 7 mL per hour e. abirb.com/test f. Equation is balanced. Estimate supports answer. g. Flow rate is excessive and needs to be reduced to 7 mL abirb.com/test per hour. Notify the prescriber promptly. Monitor the patient and blood glucose levels for hypoglycemia. 10. a. What two products must be on hand for IV administration for a severe hypoglycemic abirb.com/test reaction? b. What kinds of insulins require a bedtime snack unless otherwise ordered? c. State the reason. ANS: a. 50% Dextrose and Glucagon b. Evening insulins and long-acting insulins c. To help prevent a hypoglycemic reaction during sleep abirb.com/test abirb.com/test 11. Name the two types of diabetes mellitus. ANS: abirb.com/test DM type 1 and DM type 2 abirb.com/test 12. If a patient is to receive a premixed insulin as noted on the label below, which number indicates the intermediate-acting insulin percentage? abirb.com/test abirb.com/test abirb.com/test abirb.com/test ANS: The first number refers to the intermediate-acting insulin. abirb.com/test 13. If a patient’s blood glucose level is 295, which insulin infusion rate would you administer according the sliding scale below? Blood Glucose Level (mg per dL) 151-200 201-250 251-300 301-400 Over 400 Infusion Rate (units per hr) 1 abirb.com/test 2 3 4 abirb.com/test 5 and call MD ANS: 3 units per hr abirb.com/test 14. What is a normal fasting blood glucose range in mg per dL? ANS: abirb.com/test 70 to 100 mg per dL. The preferred norm varies among physicians. A result in the low 80 mg per dL is preferred by some physicians. Fasting means only water for 8 hours before the test. Caffeine and other products will raise the fasting blood sugar. abirb.com/test 15. What is the major side effect of insulin overdose? ANS: abirb.com/test Hypoglycemia 16. Name the route that is most commonly prescribed for patients to self-administer insulin. abirb.com/test ANS: subcut abirb.com/test 17. What is the name of the hormone that may be administered by injection for severe hypoglycemic levels? ANS: abirb.com/test Glucagon abirb.com/test 18. What is the difference between BGM and SMBG testing? abirb.com/test ANS: SMBG refers to fingerstick self-monitoring, reported by patient. BGM refers to fingerstick report, usually done by nurse. abirb.com/test 19. If a patient receives insulin and doesn’t eat, what happens to the blood glucose level? ANS: Blood glucose level drops; hypoglycemia occurs. abirb.com/test 20. If the patient doesn’t take the prescribed antidiabetic medicine, what happens to the blood glucose level? abirb.com/test ANS: Blood glucose level rises; hyperglycemia occurs. abirb.com/test 21. What is the most commonly ordered insulin concentration per mL? ANS: abirb.com/test 100 U per mL 22. When giving insulin injections subcutaneously, what area on the abdomen must be avoided and by how many inches of radius? abirb.com/test ANS: Umbilicus should be avoided by radius of 2 inches. abirb.com/test 23. A sliding scale insulin order is based on what kind of test? ANS: A current blood glucose level abirb.com/test 24. What serious ADE could the nurse expect if the dose prepared for an order of 4 units of Regular insulin and 26 units of intermediate-acting insulinabirb.com/test was reversed? ANS: The patient would rapidly become hypoglycemic and have high probability of insulin shock. abirb.com/test 25. Which specific part of the following sliding scale would necessitate clarification with the prescriber? Blood Glucose Level (mg per dL) 0-180 180-250 251-300 300-350 Over 350 ANS: Regular Insulin (units subcut) abirb.com/test 0 units 2 units 4 units abirb.com/test 6 units 8 units and call MD abirb.com/test The 180 level is indicated for two of the orders: 0 and 2 units. abirb.com/test 26. Can long-acting insulins be given IV? If so, why; if not, why not? abirb.com/test ANS: Long-acting insulins cannot be given IV. They contain additives to extend the action. abirb.com/test 27. Why are bedtime snacks such as half of a sandwich or milk ordered for patients on intermediate- and long-acting or evening insulin? ANS: abirb.com/test Intermediate-, evening, and long-acting insulins lower blood sugar during the night. To avoid hypoglycemic episodes during sleep, or during the night, a balanced small snack is given. abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test
