Nokea
Which action is most appropriate regarding the nurse's administration of a rapid-acting insulin to a hospitalized patient?
- A. Give it within 15 minutes of mealtime.
- B. Give it after the meal has been completed.
- C. Administer it once daily at the time of the midday meal.
- D. Administer it with a snack before bedtime.
Correct Answer: A
Rationale: Rapid-acting insulin, like lispro, should be given within 15 minutes of a meal to match the postprandial glucose spike, mimicking natural insulin response.
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A patient is taking a sulfonylurea medication for new-onset type 2 diabetes mellitus. When reviewing potential adverse effects during patient teaching, the nurse will include information about which of these effects? (Select all that apply.)
- A. Hypoglycemia
- B. Nausea
- C. Diarrhea
- D. Weight gain
- E. Peripheral edema
Correct Answer: A,B,D
Rationale: Sulfonylureas can cause hypoglycemia due to increased insulin secretion, nausea as a GI side effect, and weight gain from insulin stimulation. Diarrhea and edema are not common.
When teaching about hypoglycemia, the nurse will make sure that the patient is aware of the early signs of hypoglycemia, including which of these?
- A. Hypothermia and seizures
- B. Nausea and diarrhea
- C. Confusion and sweating
- D. Fruity, acetone odor to the breath
Correct Answer: C
Rationale: Early hypoglycemia signs include confusion and sweating due to central nervous system and sympathetic activation. Hypothermia and seizures are later symptoms, nausea/diarrhea are unrelated, and fruity breath indicates ketoacidosis.
The nurse is reviewing a patient's medication list and notes that sitagliptin (Januvia) is ordered. The nurse will question an additional order for which drug or drug class?
- A. Glitazone
- B. Insulin
- C. Metformin
- D. Sulfonylurea
Correct Answer: B
Rationale: Sitagliptin, a DPP-4 inhibitor, is not typically combined with insulin due to lack of established safety and efficacy. It can be used with metformin, sulfonylureas, or glitazones.
A patient with a history of chronic obstructive pulmonary disease (COPD) and type 2 diabetes has been treated for pneumonia for the past week. The patient has been receiving intravenous corticosteroids as well as antibiotics as part of his therapy. At this time, the pneumonia has resolved, but when monitoring the blood glucose levels, the nurse notices that the level is still elevated. What is the best explanation for this elevation?
- A. The antibiotics may cause an increase in glucose levels.
- B. The corticosteroids may cause an increase in glucose levels.
- C. The patient's type 2 diabetes has converted to type 1.
- D. The hypoxia caused by the COPD causes an increased need for insulin.
Correct Answer: B
Rationale: Corticosteroids increase blood glucose by inducing insulin resistance and stimulating gluconeogenesis. Antibiotics, COPD hypoxia, or type 1 conversion are not the primary causes.
The nurse is teaching a group of patients about self-administration of insulin. What content is important to include?
- A. Patients need to use the injection site that is the most accessible.
- B. If two different insulins are ordered, they need to be given in separate injections.
- C. When mixing insulins, the cloudy (such as NPH) insulin is drawn up into the syringe first.
- D. When mixing insulins, the clear (such as regular) insulin is drawn up into the syringe first.
Correct Answer: D
Rationale: When mixing insulins, clear (regular) insulin is drawn up first to prevent contamination with cloudy (NPH) insulin. Rotation of injection sites is necessary, and compatible insulins can be mixed in one syringe.