NURS 5334 EXAM 3|| ACTUAL EXAM ALL
QUESTIONS AND 100% CORRECT ANSWERS
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What drugs are used to treat gestational diabetes? - ANSWER: Metformin abd
Insulin
What A1C value indicates diabetes mellitus? Pre-DM? - ANSWER: 6.5% or
greater is considered diabetes o 5.7-6.4%pre-diabetes
What fasting and random values indicate DM? - ANSWER: Fasting plasma
glucose—126 or greater is diabetes. Random (casual) plasma glucose—anything
greater than 200 is diabetes
What are complications of insulin therapy? - ANSWER: Hypoglycemia
Can develop lipohypertrophy. Accumulation of subcutaneous fat that occurs when
it is injected too frequently at the same site. Allergic reactions
Characterized by red and intensely itchy welts, breathing becomes difficult
If severe allergy develops:
Desensitization procedure (small doses to larger doses). Hypokalemia
Promotes the uptake of potassium cells and insulin activates a membrane-bound
enzyme with sodium potassium and ATPase that pumps potassium into the cells
and sodium out
insulin drug interactions - ANSWER: o Hypoglycemicagents
Can intensify the hypoglycemia included by insulin
,2|Pag e
Examples: sulfonylureas, glinides, alcohol o
Usewithcautionwithhyperglycemicagents
Examples: thiazide and glucocorticoids and sympathomimetics
What effect do beta blockers have on insulin? - ANSWER: delay awareness of and
response to hypoglycemia by masking the signs that are associated with
stimulation of sympathetic nervous system
o Impairglycogenolysis
o Prevent the bodies counter-regulatory response
What are other therapeutic uses besides DM? - ANSWER: Hyperkalemia o Aids
in diagnosis of GH deficiency o Diabeticketoacidosis
Insulin dosage must be coordinated with what? - ANSWER: Carbohydrate intake
What is B/P goal in diabetic? - ANSWER: o To be controlled, within normal
120/80
What medication can be given to decrease risk of diabetic nephropathy? -
ANSWER: ACE inhibitor or ARB
What role does exercise play in treatment of both type 1 and type 2 DM? -
ANSWER: Exercise increases cellular responsiveness to insulin and increases
glucose tolerance o 150 minute per week of moderate intensity exercise is
recommended
What are the 4 steps in the 4-step approach? - ANSWER: Step1—diagnosis
Lifestyle changes plus metformin o Step2
,3|Pag e
Lifestyle changes plus metformin and a second drug (sulfonylurea, TZD or a
DPP4 inhibitor, a sodium glucose cotransporter or SGLT-2 inhibitor, a glucagon-
like peptide 1, or a GLP-1 receptor agonist or basal insulin
Second drug choice made considering efficacy, the hypoglycemia risk of the
patient, the patient tolerability, and weight-related considerations (some help
weight loss, some cause weight gain), cost
o Step3
Three drug combination
Metformin
Plus 2 other drugs from step 2
o Decidedbasedonadrugandpatientspecificconsiderations
o Step4
If 3 drug combination that includes basal insulin fails after 3-6 months, more
complex insulin regimen
Usually in combination with one or more non-insulin medications
When a patient is on insulin therapy what are the blood glucose goals before
meals? At bedtime? - ANSWER: Beforemeals—70-130
o Bedtime—100-140
What is the A1C goal? When is goal below 7 not appropriate? - ANSWER: 7%or
below o Those with severe hypoglycemia risk, limited life expectancy ,advanced
microvascular or
macrovascular complications—not below 7
What are the short acting insulins? Intermediate? Long acting? - ANSWER:
Shortduration:Rapidacting
Insulin lispro [Humalog]
, 4|Pag e
Insulin aspart [NovoLog]
Insulin glulisine [Apidra] o Shortduration:Sloweracting
Regular insulin [Humulin R, Novolin R] o Intermediateduration
Neutral protamine Hagedorn (NPH) insulin
Insulin detemir [Levemir] o Longduration
Insulin glargine
When are short duration insulins used? - ANSWER: Administered in association
with meals to control the post-prandial rise in blood glucose between meals and at
night
When are intermediate insulins needed? - ANSWER: Administer 2-3 times daily
to provide glycemic control between meals and during the
night
How long is duration of glargine? Levemir? Degludec? - ANSWER: Glargine—
up to 24 hours o Levemir
Low dose (0.2 units/kg)—12 hours
High doses (0.4 units/kg)—20-24 hours
o Degludec—up to 42 hours
What are routes of administration? Which can be inhaled? - ANSWER: SQ
injection IV infusion. Inhalation—Afrezza, meal time insulin
Typical insulin dosing for type 1? Type 2? - ANSWER: Total doses may range
from 0.1 unit/kg body weight to more than 2.5 units/kg Type1
Initial doses typically range from 0.5-0.6 units/kg per day Type2
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