Nokea
A client is receiving glyburide. The nurse assesses the client for a decrease in the drug's effect if which of the following drugs are initiated?
- A. Atenolol (Tenormin)
- B. Amlodipine (Norvasc)
- C. Phenytoin (Dilantin)
- D. Lithium (Eskalith)
- E. Levothyroxine (Synthroid)
Correct Answer: A,B,C,E
Rationale: Beta blockers (atenolol), calcium channel blockers (amlodipine), hydantoins (phenytoin), and thyroid agents (levothyroxine), among others, can result in decreased hypoglycemic effects of sulfonylureas (glyburide).
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A nurse is assigned to administer insulin glargine to a client at a health care facility. What precaution should the nurse take when administering this drug?
- A. Administer glargine via IV route.
- B. Avoid mixing glargine with other insulin.
- C. Shake the vial vigorously before withdrawing insulin.
- D. Be sure the insulin has been refrigerated.
Correct Answer: B
Rationale: When administering insulin glargine to the client, the nurse should avoid mixing it with other insulins or solutions. It will precipitate in the syringe when mixed. If glargine is mixed with another solution, it will lose glucose control, resulting in decreased effectiveness of the insulin. Glargine is administered via the subcutaneous route once daily at bedtime. The nurse should not shake the vial vigorously before withdrawing insulin. The vial should be gently rotated between the palms of the hands and tilted gently end to end immediately before withdrawing the insulin. The nurse administers insulin from vials at room temperature. Vials are stored in the refrigerator if they are to be stored for about 3 months for later use.
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.
After teaching an in-service presentation to a group of nurses about diabetes and insulin, the presenter determines that the presentation was successful when the group identifies which of the following as a rapid-acting insulin?
- A. Insulin aspart (NovoLog)
- B. Isophane insulin suspension (Novolin N)
- C. Insulin glargine (Lantus)
- D. Insulin detemir (Levemir)
- E. Insulin glulisine (Apidra)
Correct Answer: A,E
Rationale: Insulin aspart (NovoLog) and insulin glulisine (Apidra) are rapid-acting insulins. Isophane insulin suspension is an intermediate-acting insulin. Insulin glargine and detemir are long-acting insulins.
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.
After administering glimepiride, the nurse would assess the client for which of the following?
- A. Lactic acidosis
- B. Edema
- C. Hypoglycemia
- D. Heartburn
- E. Nausea
Correct Answer: C,D,E
Rationale: Adverse reactions associated with sulfonylureas, like glimepiride (Amaryl), include hypoglycemia, anorexia, nausea, vomiting, epigastric discomfort, weight gain, heartburn, and various vague neurologic symptoms, such as numbness and weakness of the extremities.