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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.
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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).
A client has been prescribed acarbose. Which of the following interventions should the nurse perform to promote an optimal response to the medication?
- A. Administer the drug with breakfast.
- B. Expect to add an oral sulfonylurea with the drug bends
- C. Administer the drug with the first bite of the meal.
- D. Report unusual somnolence to the primary health care provider.
Correct Answer: C
Rationale: The nurse should administer acarbose to the client with the first bite of the meal. The nurse needs to administer glyburide (Micronase) with breakfast. An oral sulfonylurea will likely be added to metformin if the client does not experience a response in 4 weeks using the maximum dose of metformin. Clients taking metformin may experience unusual somnolence, of which the nurse should inform the primary health care provider.
A client is receiving glipizide at a health care facility. The client is also prescribed an anticoagulant. The nurse would be alert for which of the following related to the interaction of these two drugs?
- A. Increased risk of lactic acidosis
- B. Risk of acute renal failure
- C. Increased risk for bleeding
- D. Increased hypoglycemic effect
Correct Answer: D
Rationale: The nurse should observe for increased hypoglycemic effect in the client as the effect of the interaction of sulfonylureas with the anticoagulants, chloramphenicol, clofibrate, fluconazole, histamine-2 antagonists, meth Methyldopa, monoamine oxidase inhibitors (MAOIs), salicylates, sulfonamides, and tricyclic antidepressants. Increased risk of lactic acidosis is an effect of the interaction of metformin with glucocorticoids. Increased risk for bleeding is an effect of the interaction of oral anticoagulants with anti-infective drugs. There is a risk of acute renal failure when iodinated contrast material used for radiologic studies is administered with metformin.
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.
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.