Nokea
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.
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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.
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).
A client who is receiving metformin develops lactic acidosis. When planning the care for this client, which nursing diagnosis would the nurse most likely identify?
- A. Ineffective Breathing Pattern
- B. Risk for Fluid Volume Deficit
- C. Acute Confusion
- D. Anxiety
Correct Answer: A
Rationale: When taking metformin, the patient is at risk for lactic acidosis manifested by unexplained hyperventilation, myalgia, malaise, GI symptoms, or unusual somnolence. Thus, a nursing diagnosis of Ineffective Breathing Pattern would be most likely. There are no problems with fluid balance. Acute Confusion would be appropriate if the client was experiencing hypoglycemia. Anxiety would be appropriate for a client who is newly diagnosed with diabetes and having difficulty accepting the diagnosis.
A nurse is preparing a presentation for a local community group about diabetes. Which of the following would the nurse include when describing type 1 diabetes?
- A. Insidious onset
- B. Occurs before age 20
- C. Insulin supplementation required for survival
- D. Formally known as non-insulin-dependent diabetes mellitus
- E. Obesity a risk factor
Correct Answer: B,C
Rationale: Type 1 diabetes is formerly known as insulin-dependent diabetes mellitus. It usually has a rapid onset and occurs before age 20. Those with type 1 diabetes produce insulin in insufficient amounts and therefore must have insulin supplementation to survive. Type 1 diabetes is an autoimmune disorder; therefore, obesity is not a risk factor.
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.