Nokea
A nurse is preparing to administer a drug that helps lower blood glucose by increasing the production of insulin by beta cells in the pancreas. Which of the following might this be?
- A. Glyburide (DiaBeta)
- B. Metformin (Glucophage)
- C. Pioglitazone (Actos)
- D. Glipizide (Glucotrol)
- E. Acarbose (Precose)
Correct Answer: A,D
Rationale: Sulfonylureas, like glyburide (DiaBeta) and glipizide (Glucotrol), help lower blood glucose by increasing the production of insulin by beta cells in the pancreas.
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A nurse is caring for a client receiving insulin detemir 10 units at bedtime. Which of the following drugs, if started, would most likely require a decrease in the dosage of insulin?
- A. Sulfamethoxazole/trimethoprim (Septra)
- B. Metoprolol (Lopressor)
- C. Fenofibrate (Tricor)
- D. Diltiazem (Verapamil)
- E. Albuterol (Ventolin)
Correct Answer: A,B,C
Rationale: Sulfonamides (sulfamethoxazole/trimethoprim), beta-blocking drugs (metoprolol), and fibrates (fenofibrate), among others, can increase the effect of insulin and require a decrease in insulin dosage to control the client's diabetes. Diltiazem and albuterol decrease the effect of insulin, requiring an increase in the dosage.
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 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 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.
A client is receiving metformin (Glucophage). The nurse suspects that the client is developing lactic acidosis based on assessment of which of the following?
- A. Malaise
- B. Hypertension
- C. Tachypnea
- D. Abdominal pain
- E. Muscular pain
Correct Answer: A,C,D,E
Rationale: Symptoms of lactic acidosis include malaise, abdominal pain, tachypnea, shortness of breath, and muscular pain.