Nokea
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.
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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 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.
A client is being discharged after being diagnosed with diabetes. The client is being taught how to monitor his blood glucose. After teaching the client, which statement indicates to the nurse that additional teaching is needed?
- A. I should prick the tip of my finger to get the blood.
- B. I should clean my finger with warm, soapy water.
- C. I should massage my finger to get a hanging drop of blood.
- D. I should avoid smearing the blood on the test strip.
Correct Answer: A
Rationale: The client should insert the lancet to prick the side of the finger, not the tip, because the side has more capillaries and fewer nerve endings. The finger should be washed with warm, soapy water and then dried before testing. The client should massage the finger to get a hanging drop of blood to be placed on the test strip. The client needs to avoid smearing the blood on the strip to prevent inaccurate readings.
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.
The nurse is assessing a client for risk factors associated with type 2 diabetes. Which of the following would the nurse identify?
- A. Younger age
- B. Impaired glucose tolerance
- C. Caucasian race
- D. Obesity
- E. History of gestational diabetes
Correct Answer: B,D,E
Rationale: A nurse should be able to identify all the risk factors for type 2 diabetes in a client. These include obesity, older age, family history of diabetes, history of gestational diabetes, impaired glucose tolerance, minimal or no physical activity, and race/ethnicity (African Americans, Hispanic Latino Americans, Native Americans, and some Asian Americans).