Nokea
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.
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When preparing to administer insulin glargine to a client, which of the following would be appropriate for the nurse to do?
- A. Check the expiration date on the vial.
- B. Shake the vial vigorously.
- C. Check the physician's orders for the type and dosage of insulin.
- D. Remove all air bubbles from the syringe barrel.
- E. Mix with short-acting insulin prior to administration.
Correct Answer: A,C,D
Rationale: Prior to administering insulin glargine (Lantus) to a client, the nurse must complete the following preadministration steps: carefully check the physician's order for the type and dosage of insulin, check the expiration date on the vial, gently rotate the vial between the palms of the hands, gently tilt end to end before withdrawing the insulin, and remove all air bubbles from the syringe barrel. The nurse should never mix or dilute insulin glargine (Lantus) with any other insulin or solution because the insulin will not be effective.
A nurse is caring for a client who has developed a hypoglycemic reaction. Which of the following interventions should the nurse perform if swallowing and gag reflexes are present In the client?
- A. Administer glucagon by the parenteral route.
- B. Administer the insulin via insulin pump.
- C. Administer oral antidiabetics to the client.
- D. Give oral fluids or candy.
Correct Answer: D
Rationale: The nurse should administer oral fluids or candy to the hypoglycemic client with swallowing and gag reflexes. If the client is unconscious, the nurse should administer glucose or glucagon parenterally. The nurse should administer insulin through an insulin pump for diabetic clients who are pregnant or have had a renal transplant. Oral antidiabetic drugs are administered to clients with type 2 diabetes.
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.
A nurse at a health care facility is assigned to administer insulin to the client. Which of the following interventions should the nurse perform before administering each insulin dose?
- A. Inspect the previous injection site for inflammation.
- B. Keep prefilled syringes horizontally.
- C. Check for symptoms of myalgia or malaise.
- D. Mix the insulin with sterile water in the syringe.
Correct Answer: A
Rationale: The nurse should check the previous injection site before administering each insulin dose. The injection sites should be rotated to prevent lipodystrophy. Prefilled syringes should not be kept horizontally; they should be kept in a vertical or oblique position to avoid plugging the needle. The nurse checks for symptoms of myalgia or malaise when administration of metformin leads to lactic acidosis. Insulin should not be mixed with other drugs in the syringe. Some types of insulin may be combined in one syringe, but sterile water is never used.