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NUR 243 Exam 3 Questions and answers latest update
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NUR 243 Exam 3A patient who has type 2 diabetes has a glycated hemoglobin A1c (HbA1c) of
10%. The nurse should make which change to the nursing care plan?
Refer the patient to a diabetes educator because the result reflects poor
glycemic control.
Glycemic control is adequate; no changes are needed.
Hypoglycemia is a risk; teach the patient the symptoms.
Instruct the patient to limit activity and weekly exercise. ANS✔✔ Refer the
patient to a diabetes educator because the result reflects poor glycemic control.
A patient who has type 2 diabetes is taking nateglinide [Starlix]. Which
response should a nurse expect the patient to have if the medication is
achieving the desired therapeutic effect?
Inhibition of carbohydrate digestion
Promotion of insulin secretion
Decreased insulin resistance
Inhibition of ketone formation ANS✔✔ Promotion of insulin secretion
Nateglinide is a meglitinide medication that acts to increase pancreatic insulin
release. It is used as an adjunct to calorie restriction and exercise to maintain
glycemic control in patients with type 2 diabetes. It does not act to reduce
insulin resistance or inhibit carbohydrate digestion. It should not be used to
manage diabetic ketone formation, because its glucose-lowering effects are too
slow to be of benefit.
,Which instruction should the nurse provide when teaching a patient to mix
regular insulin and NPH insulin in the same syringe?
"Draw up the clear regular insulin first, followed by the cloudy NPH insulin."
"It is not necessary to rotate the NPH insulin vial when it is mixed with regular
insulin."
"The order of drawing up insulin does not matter as long as the insulin is
refrigerated."
"Rotate subcutaneous injection sites each day among the arm, thigh, and
abdomen." ANS✔✔ "Draw up the clear regular insulin first, followed by the
cloudy NPH insulin."
To ensure a consistent response, only NPH insulin is appropriate for mixing
with a short-acting insulin. Unopened vials of insulin should be refrigerated;
current vials can be kept at room temperature for up to 1 month. Drawing up
the regular insulin into the syringe first prevents accidental mixture of NPH
insulin into the vial of regular insulin, which could alter the pharmacokinetics
of subsequent doses taken out of the regular insulin vial. NPH insulin is a
cloudy solution, and it should always be rotated gently to disperse the particles
evenly before loading the syringe. Subcutaneous injections should be made
using one region of the body (eg, the abdomen or thigh) and rotated within
that region for 1 month.
A patient is scheduled to start taking insulin glargine [Lantus]. On the care
plan, a nurse should include which of these outcomes related to the
therapeutic effects of the medication?
Blood glucose control for 24 hours
Mealtime coverage of blood glucose
Less frequent blood glucose monitoring
,Peak effect achieved in 2 to 4 hours ANS✔✔ Blood glucose control for 24
hours
Insulin glargine is administered as a once-daily subcutaneous injection for
patients with type 1 diabetes. It is used for basal insulin coverage, not mealtime
coverage. It has a prolonged duration, up to 24 hours, with no peaks. Blood
glucose monitoring is still an essential component to achieve tight glycemic
control.
A patient who took NPH insulin at 0800 reports feeling weak and tremulous at
1700. Which action should the nurse take?
Take the patient's blood pressure.
Give the patient's PRN dose of insulin.
Check the patient's capillary blood sugar.
Advise the patient to lie down with the legs elevated. ANS✔✔ Check the
patient's capillary blood sugar.
The patient is showing symptoms of hypoglycemia at 5:00 PM. NPH has a peak
action of 8 to 10 hours after administration. Based on the duration of action of
NPH insulin, the patient's hypoglycemic symptoms are from the 8:00 AM
injection of NPH insulin. An injection of NPH insulin at 2:00 AM, 1:00 PM, or
3:00 PM would not cause hypoglycemic symptoms based on the average
duration of action of NPH insulin.
A teaching plan for a patient who is taking lispro [Humalog] should include
which instruction by the nurse?
, "Inject this insulin with your first bite of food, because it is very fast acting."
"The duration of action for this insulin is about 8 to 10 hours, so you'll need a
snack."
"This insulin needs to be mixed with regular insulin to enhance the effects."
"To achieve tight glycemic control, this is the only type of insulin you'll need."
ANS✔✔ "Inject this insulin with your first bite of food, because it is very fast
acting."
Lispro is a rapid-acting insulin and has an onset of action of 15 to 30 minutes
with a peak action of about 2 hours, not 8 to 10 hours. Because of its rapid
onset, it is administered immediately before a meal or with meals to control
the blood glucose rise after meals. Lispro insulin must be combined with an
intermediate- or a long-acting insulin, not regular insulin (which also is a
short-duration insulin), for glucose control between meals and at night. To
achieve tight glycemic control, patients must combine different types of insulin
based on their duration of action
A patient newly diagnosed with type 1 diabetes asks a nurse, "How does
insulin normally work in my body?" The nurse explains that normal insulin
has which action in the body?
It stimulates the pancreas to reabsorb glucose.
It promotes the synthesis of amino acids into glucose.
It stimulates the liver to convert glycogen to glucose.
It promotes the passage of glucose into cells for energy. ANS✔✔ It promotes
the passage of glucose into cells for energy.
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