Nokea
A client has been prescribed acarbose. Which of the following interventions should the nurse perform to promote an optimal response to the medication?
- A. Administer the drug with breakfast.
- B. Expect to add an oral sulfonylurea with the drug bends
- C. Administer the drug with the first bite of the meal.
- D. Report unusual somnolence to the primary health care provider.
Correct Answer: C
Rationale: The nurse should administer acarbose to the client with the first bite of the meal. The nurse needs to administer glyburide (Micronase) with breakfast. An oral sulfonylurea will likely be added to metformin if the client does not experience a response in 4 weeks using the maximum dose of metformin. Clients taking metformin may experience unusual somnolence, of which the nurse should inform the primary health care provider.
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A nurse is caring for a client with diabetes mellitus who is receiving an oral antidiabetic drug. Which of following ongoing assessments should the nurse perform when caring for this client?
- A. Assess the skin for ulcers, cuts, and sores.
- B. Observe the client for hypoglycemic episodes.
- C. Monitor the client for lipodystrophy.
- D. Document family medical history.
Correct Answer: B
Rationale: As the ongoing assessment activity, the nurse should observe the client for hypoglycemic episodes. Documenting family medical history and assessing the client's skin for ulcers, cuts, and sores should be completed before administering the drug. Lipodystrophy occurs if the sites of insulin injection are not rotated.
The nurse monitoring a client receiving insulin glulisine (Apidra) notices the client has become confused, diaphoretic, and nauseated. The nurse checks the client's blood glucose and it is 60 mg/dL. Which of the following would the nurse most likely give?
- A. Orange or other fruit juice
- B. Glucose tablets
- C. Insulin glargine (Lantus)
- D. Hard candy
- E. Insulin detemir (Levemir)
Correct Answer: A,B,D
Rationale: Methods of terminating a hypoglycemic reaction include the administration of one or more of the following: orange or other fruit juice, hard candy or honey, glucose tablets, glucagon, or glucose 10% or 50% IV.
A client is being discharged after being diagnosed with diabetes. The client is being taught how to monitor his blood glucose. After teaching the client, which statement indicates to the nurse that additional teaching is needed?
- A. I should prick the tip of my finger to get the blood.
- B. I should clean my finger with warm, soapy water.
- C. I should massage my finger to get a hanging drop of blood.
- D. I should avoid smearing the blood on the test strip.
Correct Answer: A
Rationale: The client should insert the lancet to prick the side of the finger, not the tip, because the side has more capillaries and fewer nerve endings. The finger should be washed with warm, soapy water and then dried before testing. The client should massage the finger to get a hanging drop of blood to be placed on the test strip. The client needs to avoid smearing the blood on the strip to prevent inaccurate readings.
After teaching a group of nursing students about antidiabetic drugs, the instructor determines that the teaching was successful when the students identify which of the following as producing the glucose-lowering effects by delaying the digestion and absorption of carbohydrates in the intestine?
- A. Glimepiride (Amaryl)
- B. Metformin (Glucophage)
- C. Pioglitazone (Actos)
- D. Miglitol (Glyset)
- E. Acarbose (Precose)
Correct Answer: D,E
Rationale: The alpha-glucosidase inhibitors, acarbose (Precose) and miglitol (Glyset), produce their glucose-lowering effects by delaying the digestion and absorption of carbohydrates in the intestine. Glimepiride is a sulfonylurea. Metformin sensitizes the liver to circulating insulin levels and reduces hepatic glucose production. Pioglitazone decreases insulin resistance and increases insulin sensitivity by modifying several processes, resulting in decreased hepatic glucogenesis (formation of glucose from glycogen) and increased insulin-dependent muscle glucose uptake.
A client receives insulin lispro at 8 a.m. The nurse would be alert for signs and symptoms of hypoglycemia at about which time?
- A. 8:15 a.m.
- B. 9 a.m.
- C. 10 a.m.
- D. 11 a.m.
Correct Answer: B
Rationale: Insulin lispro reaches its peak action in 30 minutes to 1.5 hours. Therefore, the client's greatest risk for hypoglycemia would be during this time or about 9 a.m. Onset of action occurs in 5 to 10 minutes, so the drug would begin being effective at this time.