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GNUR 294 Review Exam 3
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GNUR 294 Review Exam 3
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GNUR 294 Review Exam 3A client is prescribed insulin via the intravenous (IV) route. Which insulin will the nurse
administer to this client? - ANS-regular
A patient who is overweight is being evaluated for diabetes. The patient has a blood
glucose level of 160 mg/dL and a hemoglobin A1c of 5.8%. The nurse understands that
this patient has which condition?
a. Diabetes mellitus
b. Hypoglycemia
c. Normal blood levels
d. Prediabetes - ANS-d. Prediabetes
Patients with a hemoglobin A1c between 5.7% and 6.4% are considered to have
prediabetes. A level of 6.5% or more indicates diabetes. The patient is hyperglycemi
A patient is ordered to receive insulin lispro at mealtimes. The nurse will instruct this
patient to administer the medication at which time?
a. 5 minutes before eating
b. 15 minutes after eating
c. 30 minutes before eating
d. 10 minutes after eating - ANS-a. 5 minutes before eating
A 45-year-old patient who is overweight has had a diagnosis of type 2 diabetes for 2
years. The patient uses 20 units of insulin per day. The patients fasting blood glucose
(FBG) is 190 mg/dL. The patient asks the nurse about using an oral antidiabetic agent.
The nurse understands that oral antidiabetic agents
a. cannot be used if the patient is overweight.
b. cannot be used once a patient requires insulin.
c. may be used since this patient meets criteria.
d. may not be used since this patients fasting blood glucose is too high. - ANS-c. may
be used since this patient meets criteria.
Patients who require less than 40 units of insulin per day and who have a fasting blood
glucose less than or equal to 200 mg/dL are candidates for oral antidiabetic agents.
Being overweight is an indication, not a contraindication.
,A patient who has insulin-dependent diabetes mellitus must take a glucocorticoid
medication for osteoarthritis. When teaching this patient, the nurse will explain that there
may be a need to
a. decrease the glucocorticoid dose.
b. decrease the insulin dose.
c. increase the glucocorticoid - ANS-c. increase the glucocorticoid
A patient who has type 2 diabetes mellitus asks the nurse why the provider has
changed the oral antidiabetic agent from tolbutamide (Orinase) to glipizide (Glucotrol).
The nurse will explain that glipizide
a. has a longer duration of action.
b. has fewer gastrointestinal side effects.
c. may be taken on an as-needed basis.
d. results in less hypoglycemic potential. - ANS-a. has a longer duration of action.
The parent of a junior high-school child who has type 1 diabetes asks the nurse if the
child can participate in sports. The nurse will tell the parent
a. that strenuous exercise is not recommended for children with diabetes.
b. that the child must be monitored for hyperglycemia while exercising.
c. to administer an extra dose of regular insulin prior to exercise.
d. to send a snack with the child to eat just prior to exercise. - ANS-d. to send a snack
with the child to eat just prior to exercise.
high glucose - ANS-insulin→ glucose into cells or converted/stored as glycogen in the
liver
low glucose - ANS-glucagon → liver breaks down glycogen (glycogenolysis) into
glucose
T1 DM Tx - ANS-Acute IV insulin & fluid. Insulin drives glucose into cells - stop acidosis
and osmotic diuresis.
Fluids→replenish fluids, restore CO
T2 DM Tx - ANS-lifestyle changes: diet control, consistent activity program
oral meds (try up to 3 different types)
insulin when oral meds no longer provide glycemic control
T1 DM - ANS-autoimmune response triggered by viral infection. Near total destruction
of pancreatic beta cells →lack of insulin
,T2 DM - ANS-excess simple CHO intake with low demand (lack of activity)→excess
glucose in blood stream→pancreas providing high amount of insulin continouously.
Hypoglycemia - ANS-not enough glucose available for cellular metabolism and energy
production, esp. in brain (requires continuous supply due to no storage)→ can occur as
a result of treatment means to control diabetes
Anti-hypoglycemic agent - ANS-Glucagon (glycogen)
Synthetic glucagon, triggers liver to release glucose into blood stream - ANS-Glucagon
MOA
(anti hypoglycemic agent)
unresponsive hypoglycemic diabetic unable to take pO (glucose tabs, juice) -
ANS-Glucagon Indications
(anti hypoglycemic agent)
Pen Injection
Immediate - ANS-Glucagon Route, Onset, Duration
(anti hypoglycemic agent)
Category B - ANS-Glucagon prg
(anti hypoglycemic agent)
Basal-bolus insulin - ANS-normal pancreatic performance, need to mimic this in insulin
therapy → long acting insulin with an intermediate or several short acting insulins
basal - ANS-constant low level of insulin release by pancreas for any random glucose
elevations.
bolus - ANS-larger amount of insulin released by pancreas in response to dietary intake.
mixing insulin - ANS-usually done only at home b/c only administering short acting in
hospital (clear always before cloudy)
Insulin - ANS-*Human Regular insulin (humulin R, Novolin)* (S.A.)
aspart (RA)
Determir (LA)
Giargine (long lasting duration)
Glulisine (RA)
, Lispro (RA)
isophane (intermediate)
SQ (Regular only IV)
SQ: 30-60min IV: 15min
6-10hrs - ANS-Human Regular Insulin - Routes, onset, Duration
(Insulin)
mono therapy for T1 DM, combination therapy with T2, DKA, HHS, gestational diabetes
- ANS-Human Regular Insulin - Indications
(Insulin)
increases cellular uptake of glucose and stimulate storage of glucose as glycogen.
Promotes storage in liver and muscles
promotes uptake of K into cells, hypokalemia can occur - ANS-Human Regular Insulin -
MOA
(Insulin)
hypoglycemia, injection site irritation, lipohyperthrophy, weight gain, hypokalemia,
somogyi phenomena - ANS-Human Regular Insulin - S/E
(Insulin)
stimulates pancreas to release more insulin
decrease resistance at cell site
Block absorption of glucose form GI tract - ANS-3 areas of action for oral drugs for
glucose control
allergy of beef and pork, hypoglycemia - ANS-Human Regular Insulin -
Contraindications
(Insulin)
oral hypoglycemics - sulfonylureas - ANS-glyburide (Diabeta, glynase, micronase)
PO
15-60min
up to 24hrs - ANS-Glyburide - Route, Onset, Duration
(oral hypoglycemics - sulfonylureas)
lower glucose in T2 DM after Diet and exercise have been ineffective - ANS-Glyburide -
indication
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