Question 1

The nurse is reviewing a patient's medication list and notes that sitagliptin (Januvia) is ordered. The nurse will question an additional order for which drug or drug class?

Accepted Answer

Sitagliptin is indicated for management of type 2 diabetes either as monotherapy or in combination with metformin, a sulfonylurea, or a glitazone, but not with insulin.

Question 2

A patient who has type 2 diabetes is scheduled for an oral endoscopy and has been NPO (nothing by mouth) since midnight. What is the best action by the nurse regarding the administration of her oral antidiabetic drugs?

Accepted Answer

When the diabetic patient is NPO, the prescriber needs to be contacted for further orders regarding the administration of the oral antidiabetic drugs. The other options are incorrect.

Question 3

When teaching a patient who is starting metformin (Glucophage), which instruction by the nurse is correct?

Accepted Answer

The GI adverse effects of metformin can be reduced by administering it with meals. The other options are incorrect.

Question 4

The nurse is preparing to administer insulin intravenously. Which statement about the administration of intravenous insulin is true?

Accepted Answer

Regular insulin is the usual insulin product to be dosed via intravenous bolus, intravenous infusion, or even intramuscularly. These routes, especially the intravenous infusion route, are often used in cases of diabetic ketoacidosis, or coma associated with uncontrolled type 1 diabetes.

Question 5

When monitoring a patient's response to oral antidiabetic drugs, the nurse knows that which laboratory result would indicate a therapeutic response?

Accepted Answer

The American Diabetes Association recommends a fasting blood glucose level of between 70 and 130 mg/dL for diabetic patients. The other options are incorrect.

Question 6

The nurse is teaching a review class to nurses about diabetes mellitus. Which statement by the nurse is correct?

Accepted Answer

Oral medications are generally not recommended for pregnant patients because of a lack of firm safety data. For this reason, insulin therapy is the only currently recommended drug therapy for pregnant women with diabetes. Insulin is given to pediatric patients, with extreme care. Patients with type 2 diabetes may require insulin in certain situations or as their disease progresses.

Question 7

The nurse is teaching a group of patients about self-administration of insulin. What content is important to include?

Accepted Answer

If mixing insulins in one syringe, the clear (regular) insulin is always drawn up into the syringe first. Patients always need to rotate injection sites. Mixing of insulins may be ordered.

Question 8

The nurse is reviewing instructions for a patient with type 2 diabetes who also takes insulin injections as part of the therapy. The nurse asks the patient, "What should you do if your fasting blood glucose is 47 mg/dL?" Which response by the patient reflects a correct understanding of insulin therapy?

Accepted Answer

Hypoglycemia can be reversed if the patient eats glucose tablets or gel, corn syrup, or honey, or drinks fruit juice or a nondiet soft drink or other quick sources of glucose, which must always be kept at hand. The patient should not wait for instructions from the physician, nor delay taking the glucose by resting. The regular insulin would only lower the blood glucose levels more.

Question 9

A patient has been diagnosed with metabolic syndrome and is started on the biguanide metformin (Glucophage). The nurse knows that the purpose of the metformin, in this situation, is which of these?

Accepted Answer

Metformin decreases glucose production by the liver; decreases intestinal absorption of glucose; and improves insulin receptor sensitivity in the liver, skeletal muscle, and adipose tissue, resulting in decreased insulin resistance. The other options are incorrect.

Question 10

The nurse is teaching a group of patients about management of diabetes. Which statement about basal dosing is correct?

Accepted Answer

Basal-bolus therapy is the attempt to mimic a healthy pancreas by delivering basal insulin constantly as a basal, and then as needed as a bolus. Glargine insulin is used as a basal dose, not as a bolus with meals. Basal-bolus therapy is a newer therapy; historically, sliding-scale coverage was implemented.

Question 11

The nurse is teaching patients about self-injection of insulin. Which statement is true regarding injection sites?

Accepted Answer

Patients taking insulin injections need to be instructed to rotate sites, but to do so within the same location for about 1 week (so that all injections are rotated in one area-for example, the right arm-before rotating to a new location, such as the left arm). Also, each injection needs to be at least 1/2 to 1 inch away from the previous site.

Question 12

The nurse knows to administer acarbose (Precose), an alpha-glucosidase inhibitor, at which time?

Accepted Answer

When an alpha-glucosidase inhibitor is taken with the first bite of a meal, excessive postprandial blood glucose elevation (a glucose spike) can be reduced or prevented.

Question 13

A patient with a history of chronic obstructive pulmonary disease (COPD) and type 2 diabetes has been treated for pneumonia for the past week. The patient has been receiving intravenous corticosteroids as well as antibiotics as part of his therapy. At this time, the pneumonia has resolved, but when monitoring the blood glucose levels, the nurse notices that the level is still elevated. What is the best explanation for this elevation?

Accepted Answer

Corticosteroids can antagonize the hypoglycemic effects of insulin, resulting in elevated blood glucose levels. The other options are incorrect.

Question 14

After starting treatment for type 2 diabetes mellitus 6 months earlier, a patient is in the office for a follow-up examination. The nurse will monitor which laboratory test to evaluate the patient's adherence to the antidiabetic therapy over the past few months?

Accepted Answer

The hemoglobin A1C level reflects the patient's adherence to the therapy regimen for several months previously, thus evaluating how well the patient has been doing with diet and drug therapy. The other options are incorrect.

Question 15

The nurse is administering insulin lispro (Humalog) and will keep in mind that this insulin will start to have an effect within which time frame?

Accepted Answer

The onset of action for insulin lispro is 15 minutes. The peak plasma concentration is 1 to 2 hours; the elimination half-life is 80 minutes; and the duration of action is 3 to 5 hours.

Question 16

When administering morning medications for a newly admitted patient, the nurse notes that the patient has an allergy to sulfa drugs. There is an order for the sulfonylurea glipizide (Glucotrol). Which action by the nurse is correct?

Accepted Answer

There is a potential for cross-allergy in patients who are allergic to sulfonamide antibiotics. Although such an allergy is listed as a contraindication by the manufacturer, most clinicians do prescribe sulfonylureas for such patients. The order needs to be clarified.

Question 17

Which action is most appropriate regarding the nurse's administration of a rapid-acting insulin to a hospitalized patient?

Accepted Answer

Rapid-acting insulins are able to mimic closely the body's natural rapid insulin output after eating a meal; for this reason, these insulins are usually administered within 15 minutes of the patient's mealtime. The other options are incorrect.

Question 18

A 75-year-old woman with type 2 diabetes has recently been placed on glipizide (Glucotrol). She asks the nurse when the best time would be to take this medication. What is the nurse's best response?

Accepted Answer

Glipizide is taken in the morning, 30 minutes before breakfast. This allows the timing of the insulin secretion induced by the glipizide to correspond with the elevation in blood glucose level induced by the meal in much the same way as endogenous insulin levels are raised in a person without diabetes.

Question 19

A patient in the emergency department was showing signs of hypoglycemia and had a fingerstick glucose level of 34 mg/dL. The patient has just become unconscious. The nurse will anticipate which action to be next?

Accepted Answer

Intravenous glucose raises blood glucose levels when the patient is unconscious and unable to take oral forms of glucose. Having the lab draw a fasting glucose level is not an appropriate action at this time.

Question 20

When teaching about hypoglycemia, the nurse will make sure that the patient is aware of the early signs of hypoglycemia, including which of these?

Accepted Answer

Early symptoms of hypoglycemia include the central nervous system manifestations of confusion, irritability, tremor, and sweating. Hypothermia and seizures are later symptoms of hypoglycemia. The other options are incorrect.

Quiz 32: Antidiabetic Drugs