Chapter 35 Drugs Used to Treat Diabetes Mellitus

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Chapter 35  Drugs Used to Treat Diabetes Mellitus

 

 

Complete Chapter Questions And Answers
 

Sample Questions

 

MULTIPLE CHOICE

1. A patient received the evening dose of Lispro subcutaneously at 16:30. What time will symptoms of hypoglycemia likely occur?
a.
19:00
b.
18:30
c.
01:30
d.
06:00

ANS: B
The most rapid-acting insulin, Lispro, peaks within 1 to 2 hours after administration. The peak time of insulin is when patients would most likely exhibit symptoms of hypoglycemia, particularly if they have inadequate dietary intake. The time of 19:00 would be past the peak of action and after signs of hypoglycemia would have appeared. The times of 01:30 and 06:00 are long after the peak of action and the time when signs of hypoglycemia would have appeared.

DIF: Cognitive Level: Application REF: Page 551 | Page 552
OBJ: 2 | 3 | 4 TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Glucose Regulation; Safety

2. It is 2:00 PM and a patient who has been NPO since 12:00 AM for a bronchoscopy is complaining of a headache and shakiness and is extremely irritable. Vital signs are within normal limits, and a one touch glucose reads 50 mg/dL. Which action is most important for the nurse to take?
a.
Have the patient eat a snack and drink milk.
b.
Administer glucagon subcutaneously.
c.
Call the bronchoscopy room to follow up with the delay.
d.
Obtain an A1c test.

ANS: B
Irritability, nervousness, headache, tremors, dizziness, apprehension, sweating, cold and clammy skin, and hunger are symptoms of hypoglycemia. The patient has not eaten since the prior day. A blood glucose of 50 mg/dL is true hypoglycemia and needs to be dealt with immediately. Glucagon is preferred over PO intake, given that an endoscopy is scheduled. Having the patient eat a snack and drink milk, calling the bronchoscopy room, and obtaining an A1c test are not appropriate responses.

DIF: Cognitive Level: Analysis REF: Page 546 OBJ: 2 | 3 | 4
TOP: Nursing Process Step: Diagnosis
MSC: NCLEX Client Needs Category: Health Promotion and Maintenance
NOT: CONCEPT(S): Clinical Judgment; Glucose Regulation; Safety

3. After a blood glucose reading, it is determined that the patient should receive 4 units of Lispro and 8 units of NPH. Which action will the nurse take to administer these medications?
a.
Draw up each insulin in separate syringes and administer two injections.
b.
Draw up the NPH first and then the Lispro using the same syringe.
c.
Administer the Lispro before the meal and the NPH after the meal.
d.
Draw up the Lispro first and then the NPH using the same syringe.

ANS: D
Lispro, an insulin analogue, is the most rapid-acting insulin. Insulin analogues are compatible with intermediate (NPH) or long-acting insulin. When combining two types of insulin, the short-acting insulin is drawn up before the intermediate-acting insulin. There is no reason to administer a second injection. The long-acting insulin is drawn up last when mixing. Insulin is to be administered before meals.

DIF: Cognitive Level: Application REF: Page 553 OBJ: 3
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Glucose Regulation; Safety

4. A patient with type 2 diabetes mellitus, which was previously controlled with an oral antidiabetic agent, is hospitalized for treatment of a leg ulcer. The health care provider has ordered sliding scale insulin coverage with regular insulin for hyperglycemia. The nurse brings the injection into the room, and the patient becomes upset, stating “I don’t want to start taking that drug! I’ll need it the rest of my life.” What is the nurse’s best response?
a.
“This is the same drug as the oral medication you were taking. It’s a stronger dose while you are in the hospital.”
b.
“Don’t worry. You shouldn’t need this too often. As you feel better, your blood glucose level will drop.”
c.
“Your body is under stress right now, which raises your blood glucose level. This does not mean you will be on this drug permanently. Once you’re feeling better, your provider will determine if your oral medication is all you will need.”
d.
“Your disease is progressing and your pancreas is producing less insulin. I know this is a hard time for you. Do you want to talk about it?”

ANS: C
Type 2 diabetes mellitus patients normally controlled with oral hypoglycemics may require insulin during situations of increased physiologic and psychological stress. The stress response stimulates epinephrine and norepinephrine, which raises the blood glucose level. Examples of stressors include pregnancy, surgery, and infections.

DIF: Cognitive Level: Application REF: Page 546 OBJ: 2 | 6
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Psychological Integrity
NOT: CONCEPT(S): Clinical Judgment; Glucose Regulation; Patient Education; Communication

5. What test determines glycemic control over the previous 8 to 10 weeks?
a.
24-hour glucose clearance test (GTT)
b.
Fructosamine test
c.
Fasting blood sugar (FBS)
d.
A1c test

ANS: D
The A1c test measures the percentage of hemoglobin that has been irreversibly glycosylated because of high blood sugar levels. This test reflects the average blood sugar level attained over the past 8 to 10 weeks. The GTT is never conducted over an interval this long. The fructosamine test measures the amount of glucose bonded to a protein, fructosamine. This reflects the average blood glucose level attained over the past 1 to 3 weeks. The FBS measures the amount of glucose in the blood before eating.

DIF: Cognitive Level: Comprehension REF: Page 547 OBJ: 2 | 3
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Health Promotion and Maintenance
NOT: CONCEPT(S): Clinical Judgment; Glucose Regulation; Safety

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