Chapter 52 Antidiatetes
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1.What will the nurse teach a patient who takes metformin (Glucophage) for type 2 diabetes?
Correct Incorrect 1
"You should take the medication with food."
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"If you miss a meal, you should skip the dose."
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"You should report any nausea immediately."
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Correct Incorrect 4
"You have an increased risk of lactic acidosis."
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Metformin causes adverse effects like abdominal bloating, nausea, a feeling of fullness, and diarrhea at
the start of the therapy. So the nurse advises the patient to take the medication with food because it helps
lessen the adverse effects. The nurse should not advise the patient to miss any meals or doses because
it may not have therapeutic effects. It is not necessary to report nausea, because it can be lessened by
taking the medication with food. Lactic acidosis is an extremely rare occurrence in patients who take
metformin.
2.
Which antidiabetic drug can be taken in combination with metformin?
Correct Incorrect 1
Miglitol (Glyset)
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Repaglinide (Prandin)
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Canagliflozin (Invokana)
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Pioglitazone HCl (Actos)
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Repaglinide (Prandin) can be taken in combination with metformin, which increases the beta cell
secretion of insulin. Miglitol (Glyset) can be taken in combination with sulfonylurea. Canagliflozin
(Invokana) can be taken in combination with exercise and diet to manage diabetes. Pioglitazone HCl
(Actos) can be taken in combination with sulfonylureas.
.
Which technique is most appropriate regarding mixing insulin when the patient must administer 30 units
regular insulin and 70 units NPH insulin in the morning?
Correct Incorrect 1
Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin.
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Correct Incorrect 2
Draw the medication into two separate syringes but inject into the same spot.
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Correct Incorrect 3
Administer these insulins at least 10 minutes apart, so that you will know when they are working.
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Correct Incorrect 4
Use the Z­track method for administration.
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Drawing up the regular insulin into the syringe first prevents accidental mixture of NPH insulin into the vial
of regular insulin, which could cause an alteration in the onset of action of the regular insulin. The
medications do not have to be in separate syringes and can be administered together. Z­track is an
intramuscular technique that is not used with insulin.
Test­Taking Tip: Try putting questions and answers in your own words to test your understanding.
4.
The nurse is teaching a patient who has been prescribed repaglinide (Prandin). Which information will the
nurse include in the teaching plan?
Correct Incorrect 1
"You will need to be sure you eat as soon as you take this medication."
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Correct Incorrect 2
"This medication is compatible with all of your cardiac medications."
IncorrectFeedback
Correct Incorrect 3
"This medication will not cause hypoglycemia."
IncorrectFeedback
Correct Incorrect 4
"This medication has no side effects."
IncorrectFeedback
Repaglinide (Prandin) is short­acting. The drug's very fast onset of action allows patients to take the drug
with meals and skip a dose when they skip a meal. Prandin interacts with beta­adrenergic blockers as
well as other medications. Hypoglycemia is a side effect of this medication, and there are many other
possible side effects of this medication.
5.
The nurse is caring for a patient who is being treated with an oral antidiabetic medication. Which common
symptom of drug toxicity will the nurse teach this patient?
Correct Incorrect 1
Headache
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Correct Incorrect 2
Hypoglycemia
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Muscle spasms
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Correct Incorrect 4
Impaired memory
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Overmedication results in several health complications in patients. Hypoglycemia is one of the major
health complications of the over dosage of diabetic medication. It is sometimes associated with side
effects such as tachycardia, diaphoresis, and fatigue. Headache and muscle spasms may not directly
affect the administration of oral diabetes drugs. Impaired memory status is the assessment included prior
to the medication regimen.
Test­Taking Tip: Be aware that information from previously asked questions may help you respond to
other examination questions.
6.
Which laboratory test would give the most accurate evidence of a diabetic patient's treatment compliance
and glucose management over the past few months?
Correct Incorrect 1
Serum albumin
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Fasting serum glucose level
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Glycosylated hemoglobin (HbA1c)
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Correct Incorrect 4
2­Hour postprandial blood glucose
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HbA1c indicates glucose concentrations over the past 3 to 4 months and thus demonstrates patient
compliance and illness management over time. The serum albumin test helps to determine the level of
natural protein in blood. The fasting serum glucose test helps to assess whether the patient has elevated
blood glucose concentrations. A 2­hour postprandial blood glucose test determines the amount of glucose
in the blood after a meal.
Test­Taking Tip: Avoid selecting answers that state hospital rules or regulations as a reason or rationale
for action.
7.
What will the nurse teach a patient who is prescribed repaglinide (Prandin) for type 2 diabetes?
Correct Incorrect 1
"Skipping two doses will cause hypoglycemia."
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Correct Incorrect 2
"You can skip one dose if you eat three meals."
IncorrectFeedback
Correct Incorrect 3
"You need to eat a meal after each dose."
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Correct Incorrect 4
"You can take sulfonylureas with repaglinide."
IncorrectFeedback
The nurse instructs the patient to eat a meal after each dose, because skipping a meal can cause
hypoglycemia. Skipping two doses of repaglinide will cause hyperglycemia in the patient, because
glucose levels will increase. The dose must be taken before each meal, and skipping either the meal or
the dose will fluctuate the glucose levels in the body. Repaglinide is not combined with sulfonylureas,
because they share a similar mechanism of action.
8.
Which early symptoms of hypoglycemia does the nurse instruct the patient's family to treat with a fast­
acting carbohydrate source? Select all that apply.
Correct Incorrect 1
Confusion
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Nervousness
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Tremor
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Sweating
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Coma
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Early symptoms of hypoglycemia involve the central nervous system, because the brain needs a constant
supply of glucose to function. Hence confusion, nervousness, tremors, and sweating are symptoms seen
in patients. When these symptoms occur, the family should have the patient immediately ingest a fast­
acting carbohydrate source such as glucagon, milk, or juice. Coma occurs if the patient's glucose levels
are not restored.
Which are rapid­acting insulins that can be administered to patients with diabetes mellitus? Select all that
apply.
Correct Incorrect 1
Lispro (Humalog)
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Regular insulin (Humulin R)
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Aspart (NovoLog)
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Glulisine (Apidra)
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Correct Incorrect 5
Glargine (Lantus)
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Lispro (Humalog), Aspart (NovoLog), and Glulisine (Apidra) are rapid­acting insulins that have an onset of
action of 15 minutes. Regular insulin (Humulin R) is a short­acting insulin that has an onset of action of
30 to 60 minutes. Glargine (Lantus) is a long­acting insulin which is dosed every 12 hours depending on
the patient's glycemic response.
10.
Which hormones play a role in regulation of glucose homeostasis? Select all that apply.
Correct Incorrect 1
Insulin
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Glucagon
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Glycogen
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Dextrose
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Correct Incorrect 5
Ketone
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Insulin and glucagon are the hormones produced by the pancreas that play an important role in the
regulation of glucose homeostasis. They are responsible for the use, mobilization, and storage of glucose
by the body. Excessive glucose in the blood is converted into glycogen and stored in the liver. When the
body breaks down fatty acids for fuel, ketones are produced as a metabolic by­product. Dextrose is the
simplest form of carbohydrate found in the body.
Test­Taking Tip: As you answer each question, write a few words about why you think that answer is
correct; in other words, justify why you selected that answer. If an answer you provide is a guess, mark
the question to identify it. This will permit you to recognize areas that need further review. It will also help
you to see how correct your “guessing” can be. Remember: on the licensure examination you must
answer each question before moving on to the next question.
11.
The nurse administers repaglinide (Prandin) to a patient at 8:00 am. When is the patient at the highest
risk for hypoglycemia?
Correct Incorrect 1
9:00 am
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Correct Incorrect 2
10:00 am
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11:00 am
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Correct Incorrect 4
Noon
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Repaglinide (Prandin) is a rapid­acting oral hypoglycemic agent whose action peaks within 1 hour of the
drug's administration. If the drug is given at 8:00 am, it will have its peak effects at 9:00 am. The drug
reaches its elimination half­life phase within the next few hours: in this case from 10:00 am to noon.
12.
A patient newly diagnosed with type 2 diabetes mellitus has been ordered insulin glargine (Lantus). What
information is essential for the nurse to teach this patient?
Correct Incorrect 1
"This medication should be mixed with the regular insulin each morning."
IncorrectFeedback
Correct Incorrect 2
"This medication is very short­acting. You must be sure you eat after injecting it."
IncorrectFeedback
Correct Incorrect 3
"This medication is very expensive, but you will be receiving it only a short time."
IncorrectFeedback
Correct Incorrect 4
"This medication has a duration of action of 24 hours."
CorrectFeedback
Insulin glargine (Lantus) has a duration of action of 24 hours with no peaks, mimicking the natural, basal
insulin secretion of the pancreas. This medication cannot be mixed with other insulins and is not a short­
acting insulin. The patient may need to receive this medication for a long time.
Test­Taking Tip: Pace yourself during the testing period and work as accurately as possible. Do not be
pressured into finishing early. Do not rush! Students who achieve higher scores on examinations are
typically those who use their time judiciously.
13.
What will the nurse teach a patient who self­administers regular insulin (Humulin R) injections?
Correct Incorrect 1
"Rotate the insulin injection site every 2 weeks."
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"Administer the insulin injection subcutaneously."
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Correct Incorrect 3
"Insert the insulin needle at a 30­degree angle."
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Correct Incorrect 4
"Administer the insulin 15 minutes before meals."
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The nurse instructs the patient to administer the injection in the subcutaneous tissue for safety and
effective absorption of insulin. The injection sites need to be rotated every week in order to prevent
lipodystrophy. The injection is administered at a 45­ to 90­ degree angle depending on the patient's size.
Regular insulin (Humulin R) is a short­acting insulin and needs to be taken 30 minutes before a meal.
Topics
14.
What precautions will the nurse take before administering insulin isophane suspension (NPH) to a
patient? Select all that apply.
Correct Incorrect 1
Shake the drug vial gently for some time
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Correct Incorrect 2
Monitor the patient's fasting serum glucose level
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Correct Incorrect 3
Identify the intramuscular injection site
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Rotate the injection locations every week
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Correct Incorrect 5
Use calibrated insulin syringes
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The nurse monitors the patient's fasting serum glucose levels before administering insulin in order to
prevent hypoglycemia. The nurse rotates the general injection site every week in order to prevent
lipodystrophy. Lipodystrophy is damage to the adipose tissue due to continued insulin injections to a
specific area. The nurse ensures that calibrated insulin syringes are used in order to administer an
accurate dose. The nurse does not shake the vial, because it causes bubbles. Instead, the nurse should
gently roll the vial to mix the contents. The nurse injects insulin into the subcutaneous tissue.
15.
Which clinical findings may indicate diabetes mellitus in a patient?
Correct Incorrect 1
Hemoglobin A1C (A1C) level of 5%
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Correct Incorrect 2
Hemoglobin A1C (A1C) level less than 5%
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Hemoglobin A1C (A1C) level greater than 6.5%
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Hemoglobin A1C (A1C) level between 5.7 and 6.4%
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A hemoglobin A1C (A1C) level greater than 6.5% is another indication of diabetes mellitus. It indicates
that the amount of sugar in the hemoglobin is higher than normal. For diagnostic purposes, an HbA1c
level of less than or equal to 5% indicates that the patient does not have diabetes, 5.7% to 6.4% indicates
prediabetes, and greater than or equal to 6.5% indicates a diagnosis of diabetes mellitus.
16.
Which statement indicates to the nurse that the patient needs additional teaching on oral hypoglycemic
agents?
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"I will limit my alcohol consumption."
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"I will report symptoms of fatigue and loss of appetite."
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"I will take the medication only when I need it."
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Correct Incorrect 4
"I will monitor my blood sugar daily."
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Oral hypoglycemic agents must be taken on a daily scheduled basis to maintain euglycemia and prevent
long­term complications of diabetes. When alcohol is ingested with certain oral hypoglycemic drugs, the
hypoglycemic effect can be intensified. The patient may experience fatigue and loss of appetite as side
effects of the medication, and these should be reported to the health care provider. The patient needs to
closely monitor blood sugar.
17.
A patient with type 1 diabetes mellitus asks, "Why can't I take a sulfonylurea like my friend who has
diabetes?" What is the nurse's best response?
Correct Incorrect 1
"Sulfonylurea increases beta­cell stimulation to secrete insulin, and your beta cells do not contain insulin."
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Correct Incorrect 2
"You must be mistaken. If your friend has diabetes mellitus, she is taking insulin."
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Correct Incorrect 3
"Sulfonylurea will lower your blood sugar too much, and you will be hypoglycemic."
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Correct Incorrect 4
"You are unable to store glucose, because you do not have insulin, and sulfonylurea helps with glucose
storage."
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Sulfonylurea agents reduce serum glucose levels by increasing beta­cell stimulation for insulin release,
decreasing hepatic glucose production, and increasing insulin sensitivity. It is administered for type 2
diabetes mellitus but will not be effective in type 1. Not all patients with type 2 diabetes require insulin, but
patients with type 1 diabetes require insulin.
Test­Taking Tip: The following are crucial requisites for doing well on the NCLEX exam: (1) A sound
understanding of the subject; (2) The ability to follow explicitly the directions given at the beginning of the
test; (3) The ability to comprehend what is read; (4) The patience to read each question and set of options
carefully before deciding how to answer the question; (5) The ability to use the computer correctly to
record answers; (6) The determination to do well; (7) A degree of confidence.
18.
The nurse is teaching a patient who has type 1 diabetes mellitus how to prevent hypoglycemia. Which
clinical indicators of hypoglycemia will the nurse identify for the patient and family? Select all that apply.
Correct Incorrect 1
Headache
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Sweating
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Polyphagia
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Weight loss
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Dehydration
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Tachycardia
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The effects of hypoglycemia are largely attributable to stimulation of the central nervous system because
low blood glucose stresses the body. When hypoglycemia occurs, the sympathetic nervous system
responds in an attempt to increase blood glucose. Clinical indicators of hypoglycemia mimic sympathetic
nervous system stimulation; they include tachycardia, palpitations, headaches, diaphoresis, and anxiety.
19.
Which factor contributes to the onset of type 2 diabetes mellitus?
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Obesity
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Genetics
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Viral infection
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Environmental conditions
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Obesity contributes to the onset of type 2 diabetes mellitus. Obesity causes stress in the endoplasmic
reticulum, which suppresses the signals of insulin receptors. Genetic factors, viral infections, and
environmental conditions are factors that contribute to the onset of type 1 diabetes mellitus.
.
Which is the most appropriate action for the nurse who is told that a patient typically takes his glipizide
(Glucotrol) with food?
Correct Incorrect 1
Immediately check the patient's blood glucose level.
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Correct Incorrect 2
Inform the patient that it is better to take the medication 30 minutes before a meal.
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Correct Incorrect 3
Inform the patient that the medication must be taken 15 minutes after a meal.
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Correct Incorrect 4
Immediately call the health care provider.
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Food inhibits the absorption of glipizide (Glucotrol), the only sulfonylurea agent that should be given 30
minutes before a meal. The blood glucose level does not have to be taken right away. The medication is
not to be taken after a meal. The health care provider does not have to be called; the nurse should
intervene.
21.
What is the nurse's best action when finding a patient with type 1 diabetes mellitus unresponsive, cold,
and clammy?
Correct Incorrect 1
Administer subcutaneous regular insulin immediately.
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Administer intravenous glucose.
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Correct Incorrect 3
Start an insulin drip.
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Correct Incorrect 4
Draw blood glucose level and send to the laboratory.
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This patient is showing signs of hypoglycemia. In the hospital setting or when the patient is unconscious,
intravenous glucose is an obvious option to treat hypoglycemia.
Test­Taking Tip: Avoid spending excessive time on any one question. Most questions can be answered
in 1 to 2 minutes
.
An operating room nurse prepares a patient who has type 2 diabetes for surgery. Which type of insulin
does the nurse administer?
Correct Incorrect 1
Regular insulin (Humulin R)
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Correct Incorrect 2
Isophane insulin suspension (NPH insulin)
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Correct Incorrect 3
Insulin zinc suspension (Lente Insulin)
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Correct Incorrect 4
Insulin glargine (Lantus)
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Regular insulin (Humulin R) is the only type of insulin that can be given intravenously. The other variants
of insulin, including isophane insulin suspension (NPH insulin), insulin zinc suspension (Lente Insulin),
and insulin glargine (Lantus) are administered through the subcutaneous route.
23.
Which site should be used for injecting insulin for the most consistent absorption?
Correct Incorrect 1
Abdomen
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Deltoid
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Correct Incorrect 3
Vastus lateralis
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Correct Incorrect 4
Gluteus maximus
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The abdomen has the most consistent absorption capacity because the blood flow to subcutaneous
tissue is not as affected by muscular movements. The deltoid is used for immunization of children and
adults. The vastus lateralis is used for immunization of infants. The gluteus maximus is not
recommended for injections because of its close proximity to the sciatic nerve and major blood vessels.
24.
What is the best method of administering glipizide (Glucotrol)?
Correct Incorrect 1
With food
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Correct Incorrect 2
30 minutes before a meal
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Correct Incorrect 3
15 minutes postprandial
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Correct Incorrect 4
At bedtime
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Glipizide (Glucotrol) is the only sulfonylurea agent that should be administered 30 minutes before a meal.
This is because the insulin secreted by the drug corresponds with the elevation in blood glucose
concentrations induced by the meal. Food inhibits the absorption of glipizide (Glucotrol). Hence, it cannot
be administered with food or in a postprandial stage or at bedtime.
Test­Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary
circumstances and that the action can be carried out in the given situation.
25.
The nurse is teaching a patient who has been prescribed repaglinide (Prandin). Which information will the
nurse include in the teaching plan?
Correct Incorrect 1
"You will need to be sure you eat as soon as you take this medication."
CorrectFeedback
Correct Incorrect 2
"When taking this medication, use aspirin rather than acetaminophen for pain relief."
IncorrectFeedback
Correct Incorrect 3
"This medication will not cause hypoglycemia."
IncorrectFeedback
Correct Incorrect 4
"You do not have to worry about side effects when taking this medication."
IncorrectFeedback
Repaglinide (Prandin) is short acting. The drug's very fast onset of action allows patients to take the drug
with meals and skip a dose when they skip a meal. The effects of repaglinide are enhanced when taken
with aspirin and other NSAIDs, which may result in increased hypoglycemia. Hypoglycemia is a side
effect of this medication, and there are many other possible side effects of this medication.
Test­Taking Tip: The computerized NCLEX exam is an individualized testing experience in which the
computer chooses your next question based on the ability and competency you have demonstrated on
previous questions. The minimum number of questions will be 75 and the maximum 265. You must
answer each question before the computer will present the next question, and you cannot go back to any
previously answered questions. Remember that you do not have to answer all of the questions correctly
to pass.
26.
Which insulin will the nurse administer to supplement basal insulin to imitate the pancreatic surge of
insulin that accompanies eating?
Correct Incorrect 1
Insulin glargine (Lantus)
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Correct Incorrect 2
Insulin glulisine (Apidra)
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Correct Incorrect 3
Insulin detemir (Levemir)
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Correct Incorrect 4
Neutral protamine Hagedorn (NPH) insulin (Humulin N)
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The nurse should administer a rapid­acting form of regular insulin, such as insulin glulisine (Apidra),
because the onset of action occurs 15 minutes after its administration. Insulin glargine (Lantus) and
insulin detemir (Levemir) are basal insulins. NPH insulin (Humulin N) is an intermediate­acting insulin that
would take too long to act in this condition.
27.
What information will the nurse teach the patient who has been prescribed an alpha glucosidase inhibitor?
Correct Incorrect 1
"This medication will stimulate pancreatic insulin release."
IncorrectFeedback
Correct Incorrect 2
"This medication will increase the sensitivity of insulin receptor sites."
IncorrectFeedback
Correct Incorrect 3
"This medication will delay the absorption of carbohydrates from the intestines."
CorrectFeedback
Correct Incorrect 4
"This medication cannot be used in combination with other antidiabetic agents."
IncorrectFeedback
Alpha glucosidase is an enzyme necessary for the absorption of glucose from the GI tract. Inhibiting this
enzyme inhibits glucose absorption, delaying rises in postprandial serum glucose levels.
.
The nurse observes that A1C levels are elevated in a patient who is taking metformin (Glucophage) for
type 2 diabetes. Which class of drugs is likely to be prescribed to this patient?
Correct Incorrect 1
Incretin mimetics
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Correct Incorrect 2
Sulfonylureas
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Correct Incorrect 3
Alpha­glucosidase inhibitors
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Correct Incorrect 4
Dipeptidyl peptidase­IV inhibitors
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Sulfonylureas are prescribed to a patient whose A1C levels are elevated even after taking metformin. The
drugs bind to specific receptors on beta cells in the pancreas to stimulate the release of insulin. Incretin
mimetics are used to reduce postprandial glucagon production. The alpha­glucosidase inhibitors are used
to control high postprandial glucose levels. The dipeptidyl peptidase­IV inhibitors are indicated as an
adjunct to diet and exercise to improve glycemic control.
29.
What instruction will the nurse give when a patient receiving metformin (Glucophage) therapy will undergo
angiography?
Correct Incorrect 1
"Do not take your metformin on the day of the test."
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Correct Incorrect 2
"You can take the medication an hour after the test."
IncorrectFeedback
Correct Incorrect 3
"There are chances of renal failure after the test."
IncorrectFeedback
Correct Incorrect 4
"You blood glucose levels need to be reevaluated."
IncorrectFeedback
Angiography uses iodinated (iodine­containing) radiologic contrast media, which interact with metformin
and may cause acute renal failure or lactic acidosis. Hence the nurse instructs the patient to discontinue
the drug on the day of the test. Metformin can be taken 48 hours after the test to prevent any adverse
effects. There are chances of renal failure after the test only if metformin is taken during the test. Blood
glucose levels are regularly evaluated in diabetic patients, but it is not a priority in this case.
30.
The patient newly diagnosed with type 2 diabetes mellitus has been ordered insulin glargine (Lantus).
What information is essential for the nurse to teach this patient?
Correct Incorrect 1
"This medication should be mixed with the regular insulin each morning."
IncorrectFeedback
Correct Incorrect 2
"This medication is very short­acting. You must be sure you eat after injecting it."
IncorrectFeedback
Correct Incorrect 3
"This medication is very expensive, but you will be receiving it only a short time."
IncorrectFeedback
Correct Incorrect 4
"This medication has a duration of action of 24 hours."
CorrectFeedback
Insulin glargine (Lantus) has a duration of action of 24 hours with no peaks, mimicking the natural, basal
insulin secretion of the pancreas. This medication cannot be mixed with other insulins and is not a short­
acting insulin. The patient may need to receive this medication for a long time.