Chapter 35: Drugs Used to Treat Diabetes Mellitus

Chapter 35: Drugs Used to Treat Diabetes Mellitus

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A patient received the evening dose of Lispro subcutaneously at 16:30. What time will symptoms of hypoglycemia likely occur?

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 19:00 would be past the peak of action and after signs of hypoglycemia would have appeared. The times of 01:30 and 06:00 are long after the peak of action and the time when signs of hypoglycemia would have appeared.

DIF:    Cognitive Level: Application           REF:   Page 551 | Page 552

OBJ:   2 | 3 | 4            TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Glucose Regulation; Safety

2. It is 2:00 PM and a patient who has been NPO since 12:00 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?

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 A_1c test are not appropriate responses.

DIF:    Cognitive Level: Analysis                REF:   Page 546        OBJ:   2 | 3 | 4

TOP:   Nursing Process Step: Diagnosis

MSC:  NCLEX Client Needs Category: Health Promotion and Maintenance

NOT:  CONCEPT(S): Clinical Judgment; Glucose Regulation; Safety

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?

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:   Page 553        OBJ:   3

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Glucose Regulation; Safety

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 don’t want to start taking that drug! I’ll need it the rest of my life.” What is the nurse’s best response?

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.

DIF:    Cognitive Level: Application           REF:   Page 546        OBJ:   2 | 6

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Psychological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Glucose Regulation; Patient Education; Communication