Chapter 36: Drugs Used to Treat Diabetes Mellitus My Nursing Test Banks

Chapter 36: Drugs Used to Treat Diabetes Mellitus

Test Bank

MULTIPLE CHOICE

1. A patient received the evening dose of Lispro subcutaneously at 1630. What time will symptoms of hypoglycemia likely occur?

a.

1900

b.

1830

c.

0130

d.

0600

ANS: B

The most rapid-acting insulin, Lispro, peaks within 1 to 2 hours after administration. The peak time of insulin is when patients would most likely exhibit symptoms of hypoglycemia, particularly if they have inadequate dietary intake. The time of 1900 would be past the peak of action and after signs of hypoglycemia would have appeared. The times of 0130 and 0600 are long after the peak of action and the time when signs of hypoglycemia would have appeared.

DIF: Cognitive Level: Application REF: p. 574 OBJ: 4 | 6 | 7

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

2. It is 2:00 PM and a patient who has been NPO since 12 AM for a bronchoscopy is complaining of a headache and shakiness, and is extremely irritable. Vital signs are within normal limits, and a one touch glucose reads 50 mg/dL. Which action is most important for the nurse to take?

a.

Have the patient eat a snack and drink milk.

b.

Administer glucagon subcutaneously.

c.

Call the bronchoscopy room to follow up with the delay.

d.

Obtain an A1c test.

ANS: B

Irritability, nervousness, headache, tremors, dizziness, apprehension, sweating, cold and clammy skin, and hunger are symptoms of hypoglycemia. The patient has not eaten since the prior day. A blood glucose of 50 mg/dL is true hypoglycemia and needs to be dealt with immediately. Glucagon is preferred over PO intake, given that an endoscopy is scheduled. Having the patient eat a snack and drink milk, calling the bronchoscopy room, and obtaining an A1c test are not appropriate responses.

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3. After a blood glucose reading, it is determined that the patient should receive 4 units of Lispro and 8 units of NPH. Which action will the nurse take to administer these medications?

a.

Draw up each insulin in separate syringes and administer two injections.

b.

Draw up the NPH first and then the Lispro using the same syringe.

c.

Administer the Lispro before the meal and the NPH after the meal.

d.

Draw up the Lispro first and then the NPH using the same syringe.

ANS: D

Lispro, an insulin analogue, is the most rapid-acting insulin. Insulin analogues are compatible with intermediate (NPH) or long-acting insulin. When combining two types of insulin, the short acting insulin is drawn up before the intermediate acting insulin. There is no reason to administer a second injection. The long-acting insulin is drawn up last when mixing. Insulin is to be administered before meals.

DIF: Cognitive Level: Application REF: p. 578 OBJ: 4 | 6

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

4. A patient with type 2 diabetes mellitus, which was previously controlled with an oral antidiabetic agent, is hospitalized for treatment of a leg ulcer. The health care provider has ordered sliding scale insulin coverage with regular insulin for hyperglycemia. The nurse brings the injection into the room, and the patient becomes upset, stating I dont want to start taking that drug! Ill need it the rest of my life. What is the nurses best response?

a.

This is the same drug as the oral medication you were taking. Its a stronger dose while you are in the hospital.

b.

Dont worry. You shouldnt need this too often. As you feel better, your blood glucose level will drop.

c.

Your body is under stress right now, which raises your blood glucose level. This does not mean you will be on this drug permanently. Once youre feeling better, your provider will determine if your oral medication is all you will need.

d.

Your disease is progressing and your pancreas is producing less insulin. I know this is a hard time for you. Do you want to talk about it?

ANS: C

Type 2 diabetes mellitus patients normally controlled with oral hypoglycemics may require insulin during situations of increased physiologic and psychological stress. The stress response stimulates epinephrine and norepinephrine, which raises the blood glucose level. Examples of stressors include pregnancy, surgery, and infections.

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TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Psychological Integrity

5. What test determines glycemic control over the previous 8 to 10 weeks?

a.

24 hour glucose clearance test (GTT)

b.

Fructosamine test

c.

Fasting blood sugar (FBS)

d.

A1c test

ANS: D

The A1c test measures the percentage of hemoglobin that has been irreversibly glycosylated because of high blood sugar levels. This test reflects the average blood sugar level attained over the past 8 to 10 weeks. The GTT is never conducted over an interval this long. The fructosamine test measures the amount of glucose bonded to a protein, fructosamine. This reflects the average blood glucose level attained over the past 1 to 3 weeks. The FBS measures the amount of glucose in the blood before eating.

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TOP: Nursing Process Step: Assessment

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6. When is the best time for the nurse to administer Lispro?

a.

After the patient has started eating

b.

Within 10 to 15 minutes of eating

c.

30 minutes before a meal

d.

45 to 60 minutes before a meal

ANS: B

Insulin analogues, such as Lispro and Aspart, are the most rapid-acting insulins. The onset of these insulins is within 10 minutes of the injection, they peak within 1 to 2 hours, and their duration is 3 to 5 hours. Patients should be eating their meal within 10 to 15 minutes of the injection.

DIF: Cognitive Level: Application REF: p. 574 OBJ: 7

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

7. Which is the most important for the successful management of diabetes mellitus?

a.

A network of community resources

b.

The level of self management

c.

Preventative education

d.

Frequent follow up with the health care provider

ANS: B

Teaching patients to self manage all aspects of their disease, including treatment modalities and preventing complications, is critical to patient success. Patients must be proficient in the entire therapeutic regimendiet, activity level, blood or urine testing, medication, self injection techniques, prevention of complications, and effective management of hypoglycemia or hyperglycemia. No outside source can overcome the failure of the patient to participate. Teaching the patient to prevent complications of his or her disease is important, but patient participation in managing the disease is crucial. No health care provider can overcome the failure of the patient to participate.

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8. What laboratory test is the preferred screening test for diabetes in children and nonpregnant adults?

a.

FPG

b.

ECG

c.

GTT

d.

A1c

ANS: A

The fasting plasma glucose (FPG) is the preferred test used to screen for diabetes in children and nonpregnant adults. Electrocardiograms (ECGs) are used to monitor electrical activity of the heart. The GTT is not recommended for routine clinical use, but may be required in the evaluation of patients with impaired fasting glucose or when diabetes is still suspected, despite a normal FPG, as with the postpartum evaluation of women with gestational diabetes mellitus. The A1c test is used to monitor diabetes management over 90 day intervals, the life of a red blood cell.

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TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

9. The patient asks the nurse how sulfonylureas normalize glucose levels. Which response by the nurse is correct?

a.

By stimulating pancreatic secretion of insulin

b.

By inhibiting secretion of insulin by the pancreas

c.

By increasing glucose production in the liver

d.

By increasing insulin metabolism in the liver

ANS: A

Sulfonylureas stimulate the pancreas to secrete more insulin. They also diminish glucose production and metabolism of insulin by the liver. The net effect is a normalization of insulin and glucose levels. Sulfonylureas decrease glucose production and hepatic metabolism of insulin.

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TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

10. The nurse is instructing a patient about insulin administration. Which statement by the patient indicates a need for further teaching?

a.

I may need more insulin if I have surgery.

b.

Once I open my insulin, I will store it in the refrigerator.

c.

I will date the insulin bottle when I open it.

d.

I will keep a spare bottle of insulin on hand.

ANS: B

Once insulin is opened and being used, it can be stored at room temperature for up to 1 month. The patient may need more insulin if undergoing surgery, should date the insulin bottle after opening, and should keep a spare bottle of insulin on hand.

DIF: Cognitive Level: Application REF: p. 570 | p. 577

OBJ: 6 TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

11. Which instruction by the nurse is accurate to include when providing teaching to a patient recently diagnosed with diabetes who has been prescribed insulin?

a.

Beta blockers can mask symptoms of hypoglycemia.

b.

Lipodystrophy increases the absorption of insulin.

c.

Infection will decrease the need for insulin.

d.

Excessive exercise will increase the need for insulin.

ANS: A

Beta adrenergic blocking agents (e.g., propranolol, timolol, nadolol, pindolol) may mask many symptoms of hypoglycemia. Lipodystrophy does not increase the absorption of insulin. Infection does not decrease the need for insulin. Excessive exercise does not increase the need for insulin.

DIF: Cognitive Level: Application REF: p. 578 OBJ: 4 | 6

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

12. Which instruction is most important for the nurse to teach a patient with diabetes who is receiving metformin?

a.

Take the medication before meals.

b.

This medication will cause the pancreas to secrete more insulin.

c.

Stop taking the drug 24 to 48 hours prior to radiopaque dye procedures.

d.

There may be an increase in the triglyceride level.

ANS: C

Radiopaque dyes often induce temporary renal insufficiency, so metformin should be discontinued 24 to 48 hours before procedures in which radiopaque dye will be administered. Metformin is not administered before meals. The pancreas does not secrete more insulin as a result of taking this medication. Metformin does not increase triglyceride levels.

DIF: Cognitive Level: Application REF: p. 579 OBJ: 5 | 6

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

13. The nurse is caring for a patient with a new diagnosis of type 1 diabetes mellitus. When assisting with the plan of care, which goal set by the patient will require revision?

a.

Patient will participate in 20 minutes of cardiovascular exercise 5 days a week.

b.

Patient will discontinue insulin use within 1 year.

c.

Patient will consume 20% of caloric intake from fat.

d.

Patient will demonstrate accurate self glucose testing skills.

ANS: B

Type 1 diabetes mellitus requires the administration of insulin injections to replace the insulin that the body is no longer able to make. Participation in a regular exercise program is a realistic goal. A diabetic diet includes 20% to 35% of calories from fat. A person diagnosed with diabetes should be able to perform glucose testing.

DIF: Cognitive Level: Analysis REF: p. 562 | p. 567

OBJ: 1 | 6 TOP: Nursing Process Step: Planning

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

14. The nurse is administering sulfonylurea drugs to four different patients diagnosed with type 2 diabetes. Which patient should not receive the medication as ordered?

a.

A 42-year-old man with hypertension

b.

A 50-year-old woman with shingles

c.

An 80-year-old woman with an allergy to sulfa

d.

A 37-year-old man with a blood glucose level of 140

ANS: C

In general, sulfonylureas should not be administered to patients who are allergic to sulfonamides. These patients may also be allergic to sulfonylureas. There is no contraindication for administering sulfonylurea drugs to a 42-year-old man with hypertension, a 50-year-old woman with shingles, or a 37-year-old man with a blood glucose level of 140.

DIF: Cognitive Level: Analysis REF: p. 581 OBJ: 6

TOP: Nursing Process Step: Assessment, Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity; Safe, Effective Care Environment

MULTIPLE RESPONSE

15. A third subclass of diabetes mellitus includes additional types of diabetes that are part of other diseases having features not generally associated with the diabetic state. Which disorder(s) may have an associated diabetic component? (Select all that apply.)

a.

Patients receiving high dose corticosteroid therapy for disease maintenance

b.

Cushings syndrome

c.

Alzheimers disease

d.

Acromegaly

e.

Malnutrition

ANS: A, B, D, E

Drugs and chemicals that induce hyperglycemia are included in the third subclass of diabetes mellitus. Cushings syndrome, acromegaly, and malnutrition are included in the third subclass of diabetes mellitus. Alzheimers disease is not included in the third subclass of diabetes mellitus.

DIF: Cognitive Level: Comprehension REF: p. 562 OBJ: 1

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

16. A 65-year-old man is diagnosed with type 2 diabetes mellitus. Which patient symptom(s) would indicate type 1 diabetes mellitus, and not type 2? (Select all that apply.)

a.

Impotence

b.

Increased thirst over the past week

c.

A 10-pound weight loss within the past month

d.

Polyphagia

e.

Ketoacidosis

ANS: B, C, D, E

Diabetes type 2 symptoms are insidious and patients present when symptoms may have been apparent for a prolonged time. Polydipsia, a 10-pound weight loss over this short period (1 month), polyphagia, and ketoacidosis are associated with type 1 diabetes. Onset of diabetes type 2 symptoms is usually in the fourth decade of life. Impotence is a symptom associated with type 2 diabetes mellitus.

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TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

17. Which dietary control measures are used in the management of diabetes mellitus? (Select all that apply.)

a.

Specific daily caloric requirements

b.

Consistent carbohydrate diabetes meal plan

c.

50% intake of carbohydrates daily

d.

Adjustments to daily meals according to age, metabolic stress, pregnancy, and advanced age and/or older adults

e.

20% intake of proteins daily

ANS: B, C, D, E

Meal planning systems are used with the diabetic patient. The consistent carbohydrate diabetes meal plan is used, with an emphasis on consistency of timing of meals and snacks. Daily meals and snacks provide 1500 to 2000 calories, with 50% of the calories from carbohydrates, 20% from protein, and 30% from fat. Individualized adjustments may be required with children, adolescents, metabolically stressed patients, pregnant women, and geriatric patients. Specific daily caloric requirement is not a primary consideration in calculating calorie requirements for a diabetic patient.

DIF: Cognitive Level: Comprehension REF: p. 563 | pp. 568-569

OBJ: 3 TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

18. Which statement(s) regarding type 2 diabetes mellitus would be correct? (Select all that apply.)

a.

Type 2 diabetes is more prevalent in overweight people older than 45 years.

b.

A genetic predisposition exists for the development of type 2 diabetes mellitus.

c.

Type 2 diabetes requires lifelong insulin replacement.

d.

Type 2 diabetes is often diagnosed after complications have resulted.

e.

Women have a higher incidence of type 2 diabetes.

ANS: A, B, D, E

Contributing factors to the development of type 2 diabetes mellitus include being older than 45 years, being overweight, and having a family predisposition to the disease. The early symptoms of this type of diabetes are minimal; therefore, many patients do not seek medical assistance until the complications have appeared. Contributing factors to the development of type 2 diabetes mellitus include being female. In type 2 diabetes mellitus, the pancreas continues to secrete insulin. Patients may be diet controlled or regulated with oral hypoglycemics. Insulin is only used if the other treatments are not effective.

DIF: Cognitive Level: Application REF: p. 562 OBJ: 1

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

19. Which statement(s) regarding gestational diabetes would be true? (Select all that apply.)

a.

It is diagnosed in about 2% of all pregnancies in the United States.

b.

It includes diabetic women who become pregnant.

c.

Fetal development may be complicated as a result of gestational diabetes.

d.

The risk of developing diabetes after pregnancy is increased.

e.

Most women with gestational diabetes have normal glucose tolerance postpartum.

f.

Women need to be re evaluated postpartum to determine their classification with respect to glucose tolerance.

ANS: C, D, E, F

Gestational diabetic individuals are put into a separate category because of the special clinical features of diabetes that develop during pregnancy and the complications associated with fetal involvement. These women are also at a greater risk of developing diabetes 5 to 10 years after pregnancy. The majority of individuals with gestational diabetes have normal glucose tolerance postpartum. Gestational diabetes patients must be reclassified 6 weeks after delivery into one of the following categories: diabetes mellitus, impaired fasting glucose, impaired glucose tolerance, or normoglycemia. Gestational diabetes is diagnosed in about 4% of all pregnancies in the United States. Gestational diabetes does not include diabetic women who become pregnant.

DIF: Cognitive Level: Comprehension REF: p. 562 OBJ: 1

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

20. The nurse is educating a patient with diabetes mellitus regarding urine testing for ketones. Information provided will include that ketone testing should be done: (Select all that apply.)

a.

when illness occurs.

b.

during pregnancy.

c.

before and after physical exercise.

d.

when blood glucose is above usual range.

e.

every morning upon awakening.

ANS: A, B, D

Ketone testing should be done when illness occurs, during pregnancy, and whenever blood glucose is elevated above the individuals usual range. It is not necessary to test urine for ketones before and after physical exercise or every morning upon awakening.

DIF: Cognitive Level: Application REF: p. 572 OBJ: 6

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

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