Nokea
Which of the following produce their glucose-lowering effect by decreasing insulin resistance and increasing insulin sensitivity?
- A. Rosiglitazone (Avandia)
- B. Metformin (Glucophage)
- C. Pioglitazone (Actos)
- D. Miglitol (Glyset)
- E. Acarbose (Precose)
Correct Answer: A,C
Rationale: The thiazolidinediones, rosiglitazone (Avandia) and pioglitazone (Actos), produce their glucose-lowering effect by decreasing insulin resistance and increasing insulin sensitivity. 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. Metformin sensitizes the liver to circulating insulin levels and reduces hepatic glucose production.
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A nurse is caring for a client diagnosed with type 2 diabetes. When teaching the client about this condition, the nurse would identify which of the following as a risk factor?
- A. Young age
- B. Regular exercise
- C. Obesity
- D. Polyuria
Correct Answer: C
Rationale: The nurse informs the client that obesity is a risk factor associated with type 2 diabetes. Young age and regular exercise are not risk factors for type 2 diabetes. Polyuria is a symptom of diabetes and not a risk factor leading to type 2 diabetes.
A nurse is preparing a presentation for a local community group about diabetes. Which of the following would the nurse include when describing type 1 diabetes?
- A. Insidious onset
- B. Occurs before age 20
- C. Insulin supplementation required for survival
- D. Formally known as non-insulin-dependent diabetes mellitus
- E. Obesity a risk factor
Correct Answer: B,C
Rationale: Type 1 diabetes is formerly known as insulin-dependent diabetes mellitus. It usually has a rapid onset and occurs before age 20. Those with type 1 diabetes produce insulin in insufficient amounts and therefore must have insulin supplementation to survive. Type 1 diabetes is an autoimmune disorder; therefore, obesity is not a risk factor.
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.
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.
A client who is receiving metformin develops lactic acidosis. When planning the care for this client, which nursing diagnosis would the nurse most likely identify?
- A. Ineffective Breathing Pattern
- B. Risk for Fluid Volume Deficit
- C. Acute Confusion
- D. Anxiety
Correct Answer: A
Rationale: When taking metformin, the patient is at risk for lactic acidosis manifested by unexplained hyperventilation, myalgia, malaise, GI symptoms, or unusual somnolence. Thus, a nursing diagnosis of Ineffective Breathing Pattern would be most likely. There are no problems with fluid balance. Acute Confusion would be appropriate if the client was experiencing hypoglycemia. Anxiety would be appropriate for a client who is newly diagnosed with diabetes and having difficulty accepting the diagnosis.