Deck 13: Drug Therapy for Diabetes

Question 1

Which drug used to treat diabetes by increasing incretins and amylin is taken orally?

A) Exenatide (Byetta)
B) Liraglutide (Victoza)
C) Pramlintide (Symlin)
D) Sitagliptin (Januvia)

Answer 1

Sitagliptin (Januvia)

Question 2

Which problem associated with insulin therapy and diabetes is intensified for a patient who is also prescribed warfarin (Coumadin)or a beta adrenergic blocker?

A) Hypoglycemia
B) Nausea/vomiting
C) Coronary artery disease
D) Risk for excessive bleeding

Answer 2

Hypoglycemia

Question 3

What makes insulin a "high-alert" drug?

A) Many people are very allergic to insulin.
B) Serious harm can occur if the wrong dose is given.
C) If too much insulin is given,the respiratory system is depressed.
D) If too much insulin is given,the blood glucose level could climb to dangerously high levels.

Answer 3

Serious harm can occur if the wrong dose is given.

Question 4

Which class of oral antidiabetic drug can cause severe hypoglycemia when used alone?

A) Alpha-glucosidase inhibitors
B) Thiazolidinediones
C) Sulfonylureas
D) Biguanides

Question 5

Which antidiabetic drug can increase the risk for pancreatitis?

A) Alogliptin (Nesina)
B) Glyburide (Diabeta)
C) Metformin (Glucophage)
D) Dapagliflozin (Farxiga)

Question 6

Which type of insulin has the shortest duration of action?

A) Rapid-acting insulin
B) Short-acting insulin
C) Intermediate-acting insulin
D) Long-acting insulin

Question 7

What is the main role of insulin in glucose (carbohydrate)metabolism?

A) Conversion of complex carbohydrates into glucose
B) Movement of glucose from blood into the cells
C) Prevention of kidney excretion of glucose
D) Prevention of the formation of fat cells

Question 8

Which term means an elevated blood sugar (glucose)level?

A) Glycogen
B) Euglycemia
C) Hypoglycemia
D) Hyperglycemia

Question 9

Which condition is the most dangerous adverse effect of insulin?

A) Hypoglycemia
B) Hyperglycemia
C) Severe hypotension
D) Development of insulin allergy

Question 10

What is the basic underlying pathology of diabetes mellitus?

A) Failure of insulin production or of insulin binding to its receptors
B) Loss of the ability for insulin to convert body fat into carbohydrates or glucose
C) Inability of pancreatic insulin to break down glycogen during periods of fasting
D) Loss of the ability of pancreatic insulin to process carbohydrates for intestinal elimination,resulting in excessively high blood glucose levels

Question 11

Which body area should never be used to inject insulin?

A) The actual umbilicus
B) The outer thighs
C) The upper arms
D) The lower back

Question 12

Which problem is a major symptom of low blood sugar levels?

A) Hypertension
B) Flushed skin
C) Weight gain
D) Confusion

Question 13

Which drug therapy class is considered the treatment of choice for people who have gestational diabetes mellitus?

A) Insulin
B) Insulin sensitizers
C) Thiazolidinediones
D) Alpha-glucosidase inhibitors

Question 14

By which action does insulin lower blood glucose levels?

A) Enhancing the enzymes that break down glucose
B) Helping glucose to move from the blood into cells
C) Converting glucose into proteins in the liver and brain
D) Converting glycogen into glucose in the liver and brain

Question 15

What is the main reason that insulin is needed as drug therapy for people who have type 1 diabetes?

A) The beta cells of the pancreas no longer make insulin.
B) The alpha cells of the pancreas no longer make insulin.
C) The beta cells of the pancreas make too much glucagon.
D) The alpha cells of the pancreas make too much glucagon.

Question 16

Which problem is a common side effect of insulin therapy?

A) Increased blood clotting
B) Decreased blood clotting
C) Injection site infection
D) Foot ulcer formation

Question 17

How does the glucose we eat influence metabolism?

A) It combines with the glucose we make to form the proteins needed to replace those lost daily in stool.
B) It is composed of extra or "empty" calories that are not necessary for life and only contribute to obesity.
C) It is used inside cells to form the high-energy substance adenosine triphosphate (ATP)needed to perform most cell functions.
D) It is converted to fats (lipids)which are used to protect the body from injury,insulate against heat loss,and provide the greatest number of needed calories.

Question 18

What is the action of the biguanide class of antidiabetic drugs that lowers blood glucose levels?

A) Directly forcing beta cells to release more insulin
B) Inhibiting the enzyme that breaks down insulin
C) Preventing the breakdown of glycogen into glucose
D) Increasing the person's need for glucose

Question 19

Which hormone has an action opposite to the action of insulin?

A) Glycogen
B) Glucagon
C) Hemoglobin A1c
D) Adenosine triphosphate

Question 20

Which oral antidiabetic drug belongs to the alpha-glucosidase inhibitor class?

A) Acarbose (Precose)
B) Glyburide (Diabeta)
C) Nateglinide (Starlix)
D) Pioglitazone (Actos)

Question 21

An older patient with diabetes is visually impaired and asks if syringes can be prefilled and stored for use later.What is your best response?

A) "Yes,prefilled syringes can be stored for up to 3 weeks in the refrigerator in a vertical position with the needle pointing up."
B) "Yes,prefilled syringes can be stored for up to 3 weeks in the refrigerator,placed in a horizontal position."
C) "Insulin reacts with plastic,so prefilled syringes must be made of glass and placed in a horizontal position."
D) "No,insulin cannot be stored for any length of time outside of the container."

Question 22

A patient who received 22 units of regular insulin an hour ago is now pale,sweaty,and has trembling hands,but is alert and able to talk.What is your best first action?

A) Prepare to administer intravenous (IV)glucose immediately.
B) Check the patient's blood glucose level immediately.
C) Notify the prescriber or rapid response team immediately.
D) Give the patient a snack containing protein and a complex carbohydrate immediately.

Question 23

A patient is receiving an injection of Humulin 70/30 at 7:00a.m.At what time should you expect the peak action for this drug?

A) Between 7:30 a.m.and 8:00 a.m.
B) Between 9:00 a.m.and 11:00 a.m.
C) Between 1:00 p.m.and 5:00 p.m.
D) Between 4:00 p.m.and 11:00 p.m.

Question 24

Which blood laboratory test result indicates that the patient is maintaining overall good control of his or her diabetes?

A) Hemoglobin A1c is 5.2%.
B) Ketone levels are negative.
C) Fasting blood glucose level is 88 mg/dL.
D) Glucose level immediately following a meal is 150%.

Question 25

What is the most important precaution to teach a patient who is on insulin therapy?

A) Avoid sharing needles with family members.
B) Do not skip meals when taking insulin.
C) Always refrigerate your insulin.
D) Avoid eating carbohydrates.

Question 26

Why is insulin only given by injection and not as an oral drug?

A) Injected insulin works faster than oral drugs to lower blood glucose levels.
B) Insulin is a small protein that is destroyed by stomach acids and intestinal enzymes.
C) Insulin is a "high-alert drug" and could more easily be abused if it were available as an oral agent.
D) Oral insulin has a high "first pass loss" rate in the liver and would require very high dosages to be effective.

Question 27

Which statement about insulin glargine is true?

A) It has no time to peak action.
B) It normally has a cloudy appearance.
C) It can be mixed with any other insulin type.
D) It should be avoided as therapy for anyone who has a sulfa allergy.

Question 28

A patient who has been newly diagnosed with diabetes and prescribed insulin therapy asks why more than one injection of insulin each day will be required.What is your best response?

A) "You need to start with multiple injections for practice until you become more proficient at self-injection."
B) "A single daily dose of insulin would not match your blood insulin levels to your food intake patterns closely enough."
C) "Using just one dose of insulin daily would require you to eat no more than one meal each day and you could not exercise."
D) "If all your insulin were in just one injection,the dose would be too large to be absorbed predictably and you would be in danger of unexpected insulin shock."

Question 29

After gently rotating a vial of isophane insulin NPH (Humulin N),you note that the drug has a cloudy appearance.What step should you take before administering it to a patient?

A) Shaking the vial for 30 seconds before using it.
B) Placing the vial in warm water to clarify the drug.
C) Discarding the current vial and opening a new one.
D) Rechecking the dosage and drawing it into the syringe.

Question 30

With which patient should you be prepared to administer glucagon as a drug?

A) 60-year-old with type 2 diabetes who has renal impairment
B) 42-year-old who has a blood glucose level of 25 mg/dL
C) 28-year-old who has type 2 diabetes and is in diabetic ketoacidosis
D) 10-year-old with a fasting blood glucose of 87 mg/dL

Question 31

How do type 1 and type 2 diabetes differ from each other?

A) Type 1 diabetes develops in people under 40 years old,whereas type 2 diabetes develops only in older people.
B) Type 2 diabetes develops in people under 40 years old,whereas type 1 diabetes develops only in older people.
C) Patients with type 1 diabetes are at higher risk for obesity and heart disease,whereas patients with type 2 diabetes are at higher risk for strokes.
D) Patients with type 1 diabetes produce no insulin,whereas patients with type 2 diabetes produce insulin but their insulin receptors are not very sensitive to it.

Question 32

Which patient taking insulin is at greatest risk for developing hypoglycemia?

A) 38-year-old who is pregnant with twins
B) 50-year-old who drinks 6 to 8 cups of coffee daily
C) 55-year-old who takes hormone replacement therapy for menopausal symptoms
D) 70-year-old who also takes warfarin (Coumadin)daily for atrial fibrillation

Question 33

A patient is prescribed to take insulin glargine once per day and regular insulin four times per day.The first dose of regular insulin occurs at the same time of the day as the insulin Glargine dose.Which technique do you use to administer these two drugs?

A) Drawing up and injecting the insulin glargine first,then drawing up and injecting the dose of regular insulin.
B) Drawing up and injecting the insulin glargine first,waiting 1 hour,then drawing up and injecting the dose of regular insulin.
C) First drawing up the dose of regular insulin,then drawing up the dose of insulin glargine in the same syringe,followed by injecting the two insulins together.
D) First drawing up the dose of insulin glargine,then drawing up the dose of regular insulin in the same syringe,followed by injecting the two insulins together.

Question 34

When teaching a patient about injection site selection and rotation,and how to self-inject insulin,which statement made by the patient indicates that clarification is needed?

A) "The abdominal site is best because it is closest to the pancreas."
B) "I can reach my thigh the best,so I will use different areas of the same thigh."
C) "By rotating the sites within one area,my chance of having tissue damage is less."
D) "If I change injection sites from the thigh to the arm,the rate the insulin is absorbed may be different."

Question 35

What is the most important action to perform before administering a premeal short-acting insulin to a patient with type 1 diabetes?

A) Looking up the time the long-acting insulin was administered
B) Assessing the body area in which the last insulin dose was injected
C) Checking whether the patient's meal or snack is already on the unit
D) Holding the dose if the patient's blood glucose level is under 110 mg/dL

Question 36

Why should you avoid aspirating the syringe before injecting an insulin dose?

A) There are no blood vessels in subcutaneous tissue.
B) The needle is too thin to penetrate the wall of a vein.
C) Tissue can be damaged by pulling it into the needle.
D) Aspirating blood into the syringe affects insulin activity.

Question 37

A patient who has been self-injecting insulin for 10 years now has warmth,redness,and pain at the injection site.What is your best action?

A) Hold the next dose of insulin and notify the prescriber as soon as possible.
B) Teach the patient to apply ice to the area and use a different site for injection.
C) Ask how long the problem has been present and assess the patient for other symptoms of infection.
D) Document the response and reassure the patient that this is a common response that requires no action.

Question 38

Which precaution is most important to teach patients who have any type of diabetes about alcohol use?

A) "Be sure to take your antidiabetic drug or drugs 15 minutes before drinking any alcohol."
B) "Only drink alcohol right before bedtime because it will make you drowsy."
C) "Increase your water intake whenever you drink alcohol."
D) "Only drink alcohol with a meal or shortly after a meal."

Question 39

When administering insulin by subcutaneous injection to a very thin patient,which adjustment in injection technique should you use to reduce the risk for complications?

A) Selecting a 30-gauge needle rather than a 28-gauge needle
B) Switching the injection site to the thigh rather than the abdomen
C) Applying pressure for at least 5 minutes after removing the needle
D) Placing the needle at a 45-degree angle rather than at a 90-degree angle

Question 40

Why is it important to maintain normal blood glucose levels in the body?

A) High levels increase the risk for heart disease,strokes,blindness,and kidney failure.
B) High levels increase the risk for seizure disorders,arthritis,osteoporosis,and bone fractures.
C) Low levels increase the risk for peripheral neuropathy,Alzheimer's disease,and premature aging.
D) Low levels increase the risk for obesity,pancreatitis,dehydration,and certain types of cancer.

Question 41

A patient who had been taking the oral antidiabetic agents glyburide and metformin is now prescribed only Glucovance.The patient asks why only one drug is needed.What is your best response?

A) "Glucovance is a new oral insulin."
B) "Your diabetes is better and only one drug is needed."
C) "This new drug is more effective than either glyburide or metformin."
D) "Glucovance contains a combination of both glyburide and metformin."

Question 42

How does acarbose (Precose)prevent blood glucose levels from rising too high?

A) It limits the intestinal enzyme that converts complex carbohydrates into glucose.
B) It blocks the absorption of carbohydrates and glucose in the intestines.
C) It enhances the binding of insulin to its membrane receptors.
D) It releases more insulin from pancreatic beta cells.

Question 43

A patient who has been prescribed sitagliptin (Januvia)calls the clinic and reports swelling of the face,lips,and tongue.What is your best response?

A) "Do not worry,this is a common side effect of the drug and does not require any changes."
B) "Take only half the drug dose and see the prescriber within the next week."
C) "Apply cold compresses to the affected areas and take an aspirin."
D) "Stop taking the drug and call 911."

Question 44

Which blood laboratory test result is most important to check before administering the first prescribed dose of miglitol (Glyset)to a patient?

A) International normalized ratio (INR)
B) Blood urea nitrogen (BUN)level
C) White blood cell (WBC)count
D) Lactate dehydrogenase (LDH)

Question 45

Which fasting blood glucose level indicates that the antidiabetic drug prescribed for a patient with type 2 diabetes is effective at maintaining target blood glucose levels?

A) 40 mg/dL
B) 80 mg/dL
C) 120 mg/dL
D) 160 mg/dL

Question 46

A patient who has been prescribed exenatide (Byetta)reports a weight loss of 11 lb in the last month.What is your best action?

A) Hold the next dose and contact the prescriber immediately.
B) Ask the patient to keep a daily diary of all foods eaten for the next month.
C) Reassure the patient that this is an expected effect of the drug and no action is needed.
D) Instruct the patient to skip one dose of the drug per day and increase his or her daily calories.

Question 47

Which assessment precaution is most important to teach a patient who is prescribed pioglitazone (Actos)as his or her only antidiabetic drug?

A) Measure your blood glucose level about 1 hour after you take this drug.
B) Note whether you experience vivid dreams or nightmares.
C) Check your urine daily for a pinkish color.
D) Weigh yourself daily and keep a record.

Question 48

A patient who usually takes metformin (Glucophage)was switched to insulin immediately following an angiogram.Which patient finding indicates it is safe for the patient to switch back to metformin?

A) 24-hour urine output greater than 2 L
B) International normalized ratio is now less than 1.2
C) Weight is unchanged from that of 1 month ago
D) Fasting blood glucose level was less than 90 mg/dL for 2 days in a row

Question 49

When teaching a patient newly diagnosed with type 2 diabetes who is prescribed to take miglitol (Glyset)as antidiabetic therapy,which instruction is most important?

A) "Rotate the injection site on a weekly basis."
B) "Take this drug with the first bite of your meal."
C) "Do not mix this drug in the same syringe as insulin."
D) "Be sure to take this drug at the usual time even if your meal is delayed."

Question 50

A patient with type 2 diabetes and heart failure who is prescribed metformin extended release (Glucophage XR)once daily now has muscle aches,drowsiness,low blood pressure,and a slow irregular heartbeat.What is your best action?

A) Assess the patient's blood glucose level and prepare to administer intravenous (IV)glucose.
B) Assess the patient's blood glucose level and prepare to administer insulin.
C) Hold the dose and notify the prescriber immediately.
D) Administer the drug at bedtime to prevent falls.

Question 51

A patient is to receive 15 units of NPH insulin and 20 units of regular insulin in the same syringe.In what order should you perform the steps to prepare this injection?
a.Make sure the syringe is free from air bubbles.
b.Check the syringe for a volume of insulin that is 35 units.
c.Clean the rubber stoppers of each bottle with separate alcohol swabs.
d.Check to make sure the concentration and types of insulin are correct.
e.Draw up 20 units of air and inject it into the regular insulin (short-acting insulin)bottle with the bottle in its normal,upright position.
f.Draw up 15 units of air and inject it into the NPH bottle with the bottle in its normal,upright position.
g.Place the same needle with the syringe attached into the NPH bottle,invert the bottle,and withdraw 15 units of NPH insulin into the same syringe with the regular insulin.
h.Without removing the needle,turn the bottle upside down and withdraw 20 units of regular insulin,then withdraw the needle from the bottle.

Question 52

By which action do the sodium-glucose cotransport inhibitors lower blood glucose levels?

A) Inhibiting the conversion of glucose to glycogen in the liver
B) Inhibiting the conversion of glycogen to glucose in the liver
C) Increasing the sensitivity of insulin receptors to insulin
D) Increasing the renal excretion of filtered glucose

Question 53

A patient who has been taking metformin (Glucophage)for a year is seen in the clinic and has all of the following laboratory results.Which result do you report to the prescriber immediately?

A) Blood urea nitrogen (BUN)38 mg/dL
B) Red blood cell (RBC)count 4.1 million/mm³
C) Random blood glucose level 135 mg/dL
D) Alkaline phosphatase 40 IU/L

Question 54

Why are oral antidiabetic drugs not effective in the management of type 1 diabetes?

A) These drugs are too powerful to give to children.
B) Patients with type 1 diabetes do not produce insulin.
C) The oral drugs are less predictable in lowering blood glucose levels.
D) Patients with type 1 diabetes are more likely to have allergies to these drugs.

Question 55

A patient who is prescribed glyburide (DiaBeta)asks if having a glass of wine once a week is okay.What is your best response?

A) "Insulin activity is dramatically reduced under the influence of alcohol,and drinking even one glass of wine will increase your insulin requirements."
B) "Diabetes reduces your kidney function,so you should avoid ingesting alcohol in all forms at all times."
C) "You should not drink any alcohol as it is likely to increase your sense of hunger and make you overeat."
D) "One glass of wine can be ingested with a meal on occasion and cause no problems."

Question 56

What precaution do you teach a patient who is prescribed to take an oral sulfonylurea agent to maintain control of blood glucose levels?

A) "Change positions slowly."
B) "Stop taking this drug at the first sign of an infection."
C) "Avoid taking nonsteroidal anti-inflammatory drugs."
D) "Do not skip a dose of the drug even if you are unable to eat."

Question 57

A patient is prescribed repaglinide (Prandin)3 mg.The drug available is repaglinide 0.5 mg/tablet.How many tablets do you administer to the patient for a correct dose?
_____ tablet(s)

Question 58

A patient newly diagnosed with type 2 diabetes who is prescribed rosiglitazone (Avandia)has all the following health problems.For which problem do you check with the prescriber to make certain rosiglitazone is an appropriate drug choice?

A) Severe asthma for the last 3 years
B) Myocardial infarction 1 year ago
C) Uncontrolled hypertension
D) Glaucoma

Question 59

A patient with type 2 diabetes is prescribed nateglinide (Starlix).Which statement indicates that the patient has a correct understanding of this therapy?

A) "I will try not to chew or break this tablet."
B) "For best results,I need to take this drug right before I eat."
C) "If this drug causes nausea,I will take it just before I go to bed."
D) "If I miss a meal,I will take this drug anyway at its regularly scheduled time."

Question 60

Why are sulfonylurea oral antidiabetic drugs not recommended for women who are breastfeeding?

A) They increase the risk of the infant developing type 2 diabetes.
B) They can lower the infant's blood glucose to dangerous levels.
C) They can cause the infant to develop an allergy to sulfa drugs.
D) They are not eliminated by the infant's immature intestinal system.