Question 1

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 the nurse's best response?&#10;A) &#34;You need to start with multiple injections for practice until you become more proficient at self-injection.&#34;&#10;B) &#34;A single daily dose of insulin would not match your blood insulin levels to your food intake patterns closely enough.&#34;&#10;C) &#34;Using just one dose of insulin daily would require you to eat no more than one meal each day and you could not exercise.&#34;&#10;D) &#34;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.&#34;

Accepted Answer

Even when a single injection of insulin contains a combined dose of different acting insulins,the timing of the actions and the timing of food intake may not match well enough to prevent wide variation in blood glucose levels.The best control of glucose levels occurs with multiple injections throughout the day.

Question 2

After gently rotating a vial of isophane insulin NPH (Humulin N),the nurse notes that the drug has a cloudy appearance.What step does the nurse take before administering it to a patient?&#10;A) Shaking the vial for 30 seconds before using it.&#10;B) Placing the vial in warm water to clarify the drug.&#10;C) Discarding the current vial and opening a new one.&#10;D) Rechecking the dosage and drawing it into the syringe.

Accepted Answer

Isophane insulin NPH is normally cloudy and does not clarify.If no particles are present,it is ready to use after gently rotating the vial to mix the drug.Insulin vials should never be shaken because this creates bubbles that interfere with obtaining the correct dosage.

Question 3

What is the most important precaution for the nurse to teach a patient who is on insulin therapy?&#10;A) Avoid sharing needles with family members.&#10;B) Do not skip meals when taking insulin.&#10;C) Always refrigerate your insulin.&#10;D) Avoid eating carbohydrates.

Accepted Answer

Although sharing needles with family members greatly increases the risk for infection and for transmission of bloodborne diseases,skipping meals while taking insulin can cause severe hypoglycemia that results in brain damage or death.Most insulins do not have to be refrigerated after opening as long as they are not exposed to high temperatures or direct sunlight.The amount of carbohydrate that a patient with diabetes eats varies with activity and control of the disease.Although they may be limited,carbohydrates should not be avoided.

Question 4

Which blood laboratory test result indicates to the nurse 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%.

Accepted Answer

Hemoglobin A₁c levels reflect the amount of fluctuation of blood glucose levels for at least the last 60 days.The closer this number is to normal,the fewer episodes of hyperglycemia the patient will have experienced.Although a fasting blood glucose level of 88% and a negative blood ketone level are good,they only reflect the control a patient has experienced for the past 24 hours.Glucose levels immediately after a meal are the least accurate way to measure glucose control.

Question 5

How does the glucose we eat influence metabolism?&#10;A) It combines with the glucose we make to form the proteins needed to replace those lost daily in stool.&#10;B) It is composed of extra or &#34;empty&#34; calories that are not necessary for life and only contribute to obesity.&#10;C) It is used inside cells to form the high energy substance adenosine triphosphate (ATP) needed to perform most cell functions.&#10;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.

Accepted Answer

Although both proteins and fats can make fuel to run the body's actions,the main fuel provider is carbohydrate.We eat carbohydrates as sugars and starches.Once inside the digestive tract,the body converts most of the carbohydrates we eat into glucose (also called dextrose).Glucose is the most common simple carbohydrate and the main fuel for the human body.Inside cells,glucose is used to form ATP,which is the main chemical energy substance that drives all the body's cellular reactions.

Question 6

The nurse is 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?&#10;A) &#34;The abdominal site is best because it is closest to the pancreas.&#34;&#10;B) &#34;I can reach my thigh the best, so I will use different areas of the same thigh.&#34;&#10;C) &#34;By rotating the sites within one area, my chance of having tissue damage is less.&#34;&#10;D) &#34;If I change injection sites from the thigh to the arm, the rate the insulin is absorbed may be different.&#34;

Accepted Answer

The abdominal site has the fastest rate of absorption because of the blood vessels in the area and not because of its proximity to the pancreas.It is a good site to use because most patients have sufficient subcutaneous tissue in the area and the patient can easily see and reach it.

Question 7

The nurse is administering insulin by subcutaneous injection to a very thin patient.Which adjustment in injection technique does the nurse use to reduce the risk for complications?&#10;A) Selecting a 30-gauge needle rather than a 28-gauge needle&#10;B) Switching the injection site to the thigh rather than the abdomen&#10;C) Applying pressure for at least 5 minutes after removing the needle&#10;D) Placing the needle at a 45-degree angle rather than at a 90-degree angle

Accepted Answer

A very thin patient has a thinner layer of subcutaneous tissue anywhere in the body compared with a patient of normal weight.Injecting at a 90-degree angle could penetrate through the thin patient's subcutaneous tissue and allow the drug to enter a muscle,which could then be absorbed too rapidly.

Question 8

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 the nurse's best first action?&#10;A) Prepare to administer intravenous (IV) glucose immediately.&#10;B) Check the patient's blood glucose level immediately.&#10;C) Notify the prescriber or rapid response team immediately.&#10;D) Give the patient a snack containing protein and a complex carbohydrate immediately.

Accepted Answer

The symptoms that the patient is experiencing are associated with hypoglycemia and that is the most likely problem,although other health issues can also cause these symptoms.Because the patient is alert and able to follow commands,IV administration of glucose is not necessary and calling the prescriber or rapid response team is not needed.It may be necessary to administer oral glucose but there is time to immediately check the patient's blood glucose level to determine how much to give.An oral snack of protein and complex carbohydrate would not be useful for an actual hypoglycemic situation although it could prevent a later hypoglycemic episode.

Question 9

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 does the nurse 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.

Accepted Answer

Insulin Glargine must not be diluted or mixed with any other insulin or solution.Mixing results in an unpredictable alteration in the onset of action and time to peak action.Thus even though these two drugs are to be administered at the same time,separate injections are needed.

Question 10

Which problem associated with insulin therapy and diabetes is intensified for a patient who also is prescribed warfarin (Coumadin)or a beta adrenergic blocker?&#10;A) Hypoglycemia&#10;B) Nausea and vomiting&#10;C) Coronary artery disease&#10;D) Risk for excessive bleeding

Accepted Answer

Some drugs intensify the effects of insulin and greatly increase the risk for hypoglycemia.In addition,drugs such as beta adrenergic blockers also reduce the patient's perception of hypoglycemia,further increasing hypoglycemic risk.Insulin does not affect the action of warfarin,so it does not increase the risk for bleeding.Although diabetes increases the risk for coronary artery disease,insulin therapy helps reduce that risk.Insulin is not associated with nausea or vomiting as side effects.

Question 11

An older patient with diabetes is visually impaired and asks if syringes can be prefilled and stored for use later.What is the nurse's best response?&#10;A) &#34;Yes, prefilled syringes can be stored for up to 3 weeks in the refrigerator in a vertical position with the needle pointing up.&#34;&#10;B) &#34;Yes, prefilled syringes can be stored for up to 3 weeks in the refrigerator, placed in a horizontal position.&#34;&#10;C) &#34;Insulin reacts with plastic, so prefilled syringes must be made of glass and placed in a horizontal position.&#34;&#10;D) &#34;No, insulin cannot be stored for any length of time outside of the container.&#34;

Accepted Answer

The answer of An older patient with diabetes is visually...

Question 12

What is the basic underlying pathology of diabetes mellitus?&#10;A) Failure of insulin production or of insulin binding to its receptors&#10;B) Loss of the ability for insulin to convert body fat into carbohydrates or glucose&#10;C) Inability of pancreatic insulin to break down glycogen during periods of fasting&#10;D) Loss of the ability of pancreatic insulin to process carbohydrates for intestinal elimination, resulting in excessively high blood glucose levels

Accepted Answer

The answer of What is the basic underlying pathology of...

Question 13

How do diabetes type 1 and diabetes type 2 differ from each other?&#10;A) Diabetes type 1 develops in people under 40 years old, whereas diabetes type 2 develops only in older people.&#10;B) Diabetes type 2 develops in people under 40 years old, whereas diabetes type 1 develops only in older people.&#10;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.&#10;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.

Accepted Answer

The answer of How do diabetes type 1 and diabetes...

Question 14

Why does the nurse avoid aspirating the syringe before injecting an insulin dose?&#10;A) There are no blood vessels in subcutaneous tissue.&#10;B) The needle is too thin to penetrate the wall of a vein.&#10;C) Tissue can be damaged by pulling it into the needle.&#10;D) Aspirating blood into the syringe affects insulin activity.

Accepted Answer

The answer of Why does the nurse avoid aspirating the...

Question 15

What is the main role of insulin in glucose (carbohydrate)metabolism?&#10;A) Conversion of complex carbohydrates into glucose&#10;B) Movement of glucose from blood into the cells&#10;C) Prevention of kidney excretion of glucose&#10;D) Prevention of the formation of fat cells

Accepted Answer

The answer of What is the main role of insulin...

Question 16

What is the most important action for the nurse to perform before administering a premeal short-acting insulin to a patient with type 1 diabetes?&#10;A) Looking up the time the long-acting insulin was administered&#10;B) Assessing the body area in which the last insulin dose was injected&#10;C) Checking whether the patient's meal or snack is already on the unit&#10;D) Holding the dose if the patient's blood glucose level is under 110 mg/dL

Accepted Answer

The answer of What is the most important action for...

Question 17

A patient who has been self-injecting insulin for 10 years now has warmth,redness,and pain at the injection site.What is the nurse's best action?&#10;A) Hold the next dose of insulin and notify the prescriber as soon as possible.&#10;B) Teach the patient to apply ice to the area and use a different site for injection.&#10;C) Ask how long the problem has been present and assess the patient for other symptoms of infection.&#10;D) Document the response and reassure the patient that this is a common response that requires no action.

Accepted Answer

The answer of A patient who has been self-injecting insulin...

Question 18

Which condition is the most dangerous adverse effect of insulin?&#10;A) Hypoglycemia&#10;B) Hyperglycemia&#10;C) Severe hypotension&#10;D) Development of insulin allergy

Accepted Answer

The answer of Which condition is the most dangerous adverse...

Question 19

Why is insulin only given by injection and not as an oral drug?&#10;A) Injected insulin works faster than oral drugs to lower blood glucose levels.&#10;B) Insulin is a small protein that is destroyed by stomach acids and intestinal enzymes.&#10;C) Insulin is a &#34;high-alert drug&#34; and could more easily be abused if it were available as an oral agent.&#10;D) Oral insulin has a high &#34;first pass loss&#34; rate in the liver and would require very high dosages to be effective.

Accepted Answer

The answer of Why is insulin only given by injection...

Question 20

Why is it important to maintain normal blood glucose levels in the body?&#10;A) High levels increase the risk for heart disease, strokes, blindness, and kidney failure.&#10;B) High levels increase the risk for seizure disorders, arthritis, osteoporosis, and bone fractures.&#10;C) Low levels increase the risk for peripheral neuropathy, Alzheimer's disease, and premature aging.&#10;D) Low levels increase the risk for obesity, pancreatitis, dehydration, and certain types of cancer.

Accepted Answer

The answer of Why is it important to maintain normal...

Question 21

Why are oral antidiabetic drugs not effective in the management of type 1 diabetes?&#10;A) These drugs are too powerful to give to children.&#10;B) Patients with type 1 diabetes do not produce insulin.&#10;C) The oral drugs are less predictable in lowering blood glucose levels.&#10;D) Patients with type 1 diabetes are more likely to have allergies to these drugs.

Accepted Answer

The answer of Why are oral antidiabetic drugs not effective...

Question 22

How does acarbose (Precose)prevent blood glucose levels from rising too high?&#10;A) It limits the intestinal enzyme that converts complex carbohydrates into glucose.&#10;B) It blocks the absorption of carbohydrates and glucose in the intestines.&#10;C) It enhances the binding of insulin to its membrane receptors.&#10;D) It releases more insulin from pancreatic beta cells.

Accepted Answer

The answer of How does acarbose (Precose)prevent blood glucose levels...

Question 23

Which fasting blood glucose level indicates to the nurse that the antidiabetic drug that has been prescribed for a patient with type 2 diabetes is effective at maintaining target blood glucose levels?&#10;A) 40 mg/dL&#10;B) 80 mg/dL&#10;C) 120 mg/dL&#10;D) 160 mg/dL

Accepted Answer

The answer of Which fasting blood glucose level indicates to...

Question 24

Which assessment precaution is most important for the nurse to teach a patient who is prescribed pioglitazone (Actos)as his or her only antidiabetic drug?&#10;A) Measure your blood glucose level about 1 hour after you take this drug.&#10;B) Note whether you experience vivid dreams or nightmares.&#10;C) Check your urine daily for a pinkish color.&#10;D) Weigh yourself daily and keep a record.

Accepted Answer

The answer of Which assessment precaution is most important for...

Question 25

A patient with type 2 diabetes is prescribed nateglinide (Starlix).Which statement indicates to the nurse that the patient has a correct understanding of this therapy?&#10;A) &#34;I will try not to chew or break this tablet.&#34;&#10;B) &#34;For best results, I need to take this drug right before I eat.&#34;&#10;C) &#34;If this drug causes nausea, I will take it just before I go to bed.&#34;&#10;D) &#34;If I miss a meal, I will take this drug anyway at its regularly scheduled time.&#34;

Accepted Answer

The answer of A patient with type 2 diabetes is...

Question 26

Why are sulfonylurea oral antidiabetic drugs not recommended for women who are breastfeeding?&#10;A) They increase the risk of the infant developing type 2 diabetes.&#10;B) They can lower the infant's blood glucose to dangerous levels.&#10;C) They can cause the infant to develop an allergy to sulfa drugs.&#10;D) They are not eliminated by the infant's immature intestinal system.

Accepted Answer

The answer of Why are sulfonylurea oral antidiabetic drugs not...

Question 27

A patient is to receive 15 units of NPH insulin and 20 units of regular insulin in the same syringe.In what order does the nurse perform the steps to prepare this injection? &#10;A)Make sure the syringe is free from air bubbles.&#10;B)Check the syringe for a volume of insulin that is 35 units.&#10;C)Clean the rubber stoppers of each bottle with separate alcohol swabs.&#10;D)Check to make sure the concentration and types of insulin are correct.&#10;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.&#10;F)Draw up 15 units of air and inject it into the NPH bottle with the bottle in its normal,upright position.&#10;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.&#10;H)Without removing the needle,turn the bottle upside down and withdraw 20 units of regular insulin,then withdraw the needle from the bottle.

Accepted Answer

The answer of A patient is to receive 15 units...

Question 28

A patient who is prescribed glyburide (DiaBeta)asks if having a glass of wine once a week is okay.What is the nurse's best response?&#10;A) &#34;Insulin activity is dramatically reduced under the influence of alcohol, and drinking even one glass of wine will increase your insulin requirements.&#34;&#10;B) &#34;Diabetes reduces your kidney function, so you should avoid ingesting alcohol in all forms at all times.&#34;&#10;C) &#34;You should not drink any alcohol as it is likely to increase your sense of hunger and make you overeat.&#34;&#10;D) &#34;One glass of wine can be ingested with a meal on occasion and cause no problems.&#34;

Accepted Answer

The answer of A patient who is prescribed glyburide (DiaBeta)asks...

Question 29

A patient who has been prescribed sitagliptin (Januvia)calls the clinic and reports swelling of the face,lips,and tongue.What is the nurse's best response?&#10;A) &#34;Do not worry, this is a common side effect of the drug and does not require any changes.&#34;&#10;B) &#34;Take only half the drug dose and see the prescriber within the next week.&#34;&#10;C) &#34;Apply cold compresses to the affected areas and take an aspirin.&#34;&#10;D) &#34;Stop taking the drug and call 911.&#34;

Accepted Answer

The answer of A patient who has been prescribed sitagliptin...

Question 30

A patient is prescribed repaglinide (Prandin)3 mg.The drug available is repaglinide 0.5 mg per tablet.How many tablets does the nurse administer to the patient?&#10;_____ tablet(s)

Accepted Answer

The answer of A patient is prescribed repaglinide (Prandin)3 mg.The...

Question 31

A patient who has been prescribed exenatide (Byetta)reports a weight loss of 11 lb in the last month.What is the nurse's best action?&#10;A) Hold the next dose and contact the prescriber immediately.&#10;B) Ask the patient to keep a daily diary of all foods eaten for the next month.&#10;C) Reassure the patient that this is an expected effect of the drug and no action is needed.&#10;D) Instruct the patient to skip one dose of the drug per day and increase his or her daily calories.

Accepted Answer

The answer of A patient who has been prescribed exenatide...

Question 32

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 the nurse's best response?&#10;A) &#34;Glucovance is a new oral insulin.&#34;&#10;B) &#34;Your diabetes is better and only one drug is needed.&#34;&#10;C) &#34;This new drug is more effective than either glyburide or metformin.&#34;&#10;D) &#34;Glucovance contains a combination of both glyburide and metformin.&#34;

Accepted Answer

The answer of A patient who had been taking the...

Question 33

What precaution does the nurse teach a patient who is prescribed to take an oral sulfonylurea agent to maintain control of blood glucose levels?&#10;A) &#34;Change positions slowly.&#34;&#10;B) &#34;Stop taking this drug at the first sign of an infection.&#34;&#10;C) &#34;Avoid taking nonsteroidal anti-inflammatory drugs.&#34;&#10;D) &#34;Do not skip a dose of the drug even if you are unable to eat.&#34;

Accepted Answer

The answer of What precaution does the nurse teach a...

Question 34

Which blood laboratory test result is most important for the nurse to check before administering the first prescribed dose of miglitol (Glyset)to a patient?&#10;A) International normalized ratio (INR)&#10;B) Blood urea nitrogen (BUN) level&#10;C) White blood cell (WBC) count&#10;D) Lactate dehydrogenase

Accepted Answer

The answer of Which blood laboratory test result is most...

Question 35

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 the nurse's 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.

Accepted Answer

The answer of A patient with type 2 diabetes and...

Question 36

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 does the nurse 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 international units per liter

Accepted Answer

The answer of A patient who has been taking metformin...

Question 37

A patient newly diagnosed with type 2 diabetes who is prescribed rosiglitazone (Avandia)has all the following health problems.For which problem does the nurse 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

Accepted Answer

The answer of A patient newly diagnosed with type 2...

Deck 25: Drugs for Diabetes