Nokea
A nurse is caring for a client receiving insulin glargine (Lantus) 20 units at bedtime. Initiation of which of the following drugs may increase the client's insulin requirement?
- A. Methylprednisolone (Medrol)
- B. Metoprolol (Lopressor)
- C. Fenofibrate (Tricor)
- D. Estradiol (Estrace)
- E. Niacin (Niaspan)
Correct Answer: A,D,E
Rationale: Corticosteroids (methylprednisolone), estrogens (estradiol), and niacin (Niaspan) are among the drugs that can decrease the effect of insulin and require an increase in insulin dosage to control the client's diabetes. Beta blockers and fibrates increase the effect of insulin and thus may require a decrease in the dosage of insulin.
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A nurse should monitor a client taking glyburide (DiaBeta) for increased hypoglycemic effect if which of the following drugs are initiated?
- A. Ranitidine (Zantac)
- B. Warfarin (Coumadin)
- C. Digoxin (Lanoxin)
- D. Lithium (Eskalith)
- E. Amitriptyline (Elavil)
Correct Answer: A,B,E
Rationale: H2 antagonists (ranitidine), anticoagulants (warfarin), and tricyclic antidepressants (amitriptyline), among others, can result in increased hypoglycemic effects of sulfonylureas (glyburide).
A nurse is caring for a client with type 2 diabetes receiving a meglitinide. The nurse reviews the clients medical record based on the understanding that which condition would contraindicate the use of this drug?
- A. Diabetic ketoacidosis
- B. Kidney disease
- C. Severe heart failure
- D. Liver disease
Correct Answer: A
Rationale: Meglitinides are contraindicated in clients with diabetic ketoacidosis and severe endocrine disease. Thiazolidinediones are contraindicated in clients with severe heart failure and used with caution in clients with kidney disease, severe heart failure, and liver disease.
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 prescribed miglitol. The nurse would instruct the client to administer this drug at which time?
- A. At bedtime
- B. Three times a day with the first bite of a meal
- C. 30 minutes before eating breakfast
- D. Before or after a meal during the day
Correct Answer: B
Rationale: Miglitol is given three times a day with the first bite of the meal because food increases absorption.
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.