The nurse is instructing a group of diabetic patients. What diabetic drug must the nurse tell the patients how to protect themselves from the sun?
a. Insulin
b. Glipizide (Glucotrol)
c. Metformin (Glucophage)
d. Nateglinide (Starlix)
B.
Teach patients taking a sulfonylurea like Glipizide are taught to avoid direct sunlight, use sunscreen, and wear protective clothing (including a hat) whenever sun exposure is likely to occur to prevent a severe sunburn. Sulfonylureas increase sun sens
A patient who has been self-injecting insulin for 10 years now has warmth, redness, and pain at the injection site. What is your best action?
a. Hold the next dose of insulin and notify the prescriber as soon as possible.
b. Teach the patient to apply ice
C
These symptoms are indicators of injection site infection. Patients with diabetes are at a greater risk for any type of infection, and infections can become severe very quickly. The nurse must determine if the area is infected or just irritated. Other i
Why are oral antidiabetic drugs not effective in the management of type 1 diabetes?
a. These drugs are too powerful to give to children.
b. Patients with type 1 diabetes do not produce insulin.
c. The oral drugs are less predictable in lowering blood gluc
B
Oral antidiabetic drugs are not insulin. Most just help the patient use his or her naturally produced insulin more efficiently, although some drugs also prevent glucose from entering the blood too quickly.
How does acarbose (Precose) prevent blood glucose levels from rising too high?
a. It limits the intestinal enzyme that converts complex carbohydrates into glucose.
b. It blocks the absorption of carbohydrates and glucose in the intestines.
c. It enhances
A
Acarbose is an alpha-glucosidase inhibitor. Drugs from this class work by slowing the digestion of dietary starches and other carbohydrates by inhibiting an enzyme that breaks them down into glucose. The result of this action is that blood glucose does
When teaching a patient newly diagnosed with type 2 diabetes who is prescribed to take miglitol (Glyset) as antidiabetic therapy, which instruction is most important?
a. "Rotate the injection site on a weekly basis."
b. "Take this drug with the first bite
B
Miglitol is an oral antidiabetic drug from the alpha-glucosidase inhibitor class. Its action is to slow the digestion of starches and other carbohydrates in the intestinal tract. In order to be effective, it must be taken at the beginning of a meal.
A patient with type 2 diabetes and heart failure who is prescribed metformin extended release (Glucophage XR) once daily now has muscle aches, drowsiness, low blood pressure, and a slow irregular heartbeat. What is your best action?
a. Assess the patient'
C
The muscle aches, drowsiness, low blood pressure, and a slow irregular heartbeat are symptoms of lactic acidosis, an adverse reaction to metformin. The drug should be stopped and the prescriber notified so that steps can be taken to reduce the acidosis.
A patient with diabetes is scheduled for an angiogram. What antidiabetic medication does the nurse tell the patient to avoid within 48 hours after the procedure?
a. Insulin
b. Glipizide (Glucotrol)
c. Metformin (Glucophage)
d. Rosiglitazone (Avandia)
C.
Tests that involve the use of radio-opaque dye (such as urograms, angiograms, and other scans) can lead to kidney failure with metformin, usually within 48 hours. A patient who takes metformin may take the dose before receiving the dye but should not r
By which action do the sodium-glucose cotransport inhibitors lower blood glucose levels?
a. Inhibiting the conversion of glucose to glycogen in the liver
b. Inhibiting the conversion of glycogen to glucose in the liver
c. Increasing the sensitivity of ins
D
The sodium-glucose cotransport inhibitors inhibit the reabsorption of filtered glucose in the kidney so that more is removed from the body in the urine. It has no action on liver glucose or glycogen, and does not increase insulin receptor sensitivity.
A patient newly diagnosed with type 2 diabetes who is prescribed rosiglitazone (Avandia) has all the following health problems. For which problem do you check with the prescriber to make certain rosiglitazone is an appropriate drug choice?
a. Severe asthm
B
Rosiglitazone carries a black box warning because it can cause heart failure in some patients. Patients most at risk are those who have had a previous myocardial infarction. Although heart failure can worsen asthma, it is not worsened by rosiglitazone,
Which blood laboratory test result is most important to check before administering the first prescribed dose of miglitol (Glyset) to a patient?
a. International normalized ratio (INR)
b. Blood urea nitrogen (BUN) level
c. White blood cell (WBC) count
d. L
ANS: D
Miglitol is an alpha-glucosidase inhibitor. Drugs from this class can cause liver impairment. They should not be prescribed for anyone who already had a change in liver function. A common test of liver function is blood levels of lactate dehydrogen
What precaution do you teach a patient who is prescribed to take an oral sulfonylurea agent to maintain control of blood glucose levels?
a. "Change positions slowly."
b. "Stop taking this drug at the first sign of an infection."
c. "Avoid taking nonsteroi
C
Nonsteroidal anti-inflammatory drugs (NSAIDs) potentiate the hypoglycemic effects of sulfonylurea agents. Patients should avoid these drugs altogether or use them with great caution.
A diabetic patient has been prescribed exenatide (Byetta). The nurse knows that what is the mechanism of action for this drug?
a. It triggers the pancreas to release insulin to handle the glucose ingested.
b. It makes insulin receptors more sensitive to i
A
Exenatide (Byetta) is an incretin mimetic (GLp-1 agonists) and a member of a class of noninsulin antidiabetic drugs that work by acting like natural "gut" hormones that are secreted with meals at the same time insulin is secreted. Byetta triggers the pa
A patient who had been taking the oral antidiabetic agents glyburide and metformin is now prescribed only Glucovance. The patient asks why only one drug is needed. What is your best response?
a. "Glucovance is a new oral insulin."
b. "Your diabetes is bet
D
Glucovance is composed of glyburide and metformin in commonly used dosages to increase the convenience of antidiabetic therapy with both drugs.
A patient with type 2 diabetes is prescribed nateglinide (Starlix). Which statement indicates that the patient has a correct understanding of this therapy?
a. "I will try not to chew or break this tablet."
b. "For best results, I need to take this drug ri
B
Nateglinide causes beta cells of the pancreas to undergo depolarization and release a small amount of preformed insulin. The peak action occurs in about 20 minutes after ingestion. To have the best action and prevent hypoglycemia, patients are instructe
A patient who usually takes metformin (Glucophage) was switched to insulin immediately following an angiogram. Which patient finding indicates it is safe for the patient to switch back to metformin?
a. 24-hour urine output greater than 2 L
b. Internationa
A
Metformin can cause renal impairment when the patient is also exposed to radio-opaque dyes and some anesthetic agents. This can happen up to 48 hours after the exposure. The drug can be restarted after 48 hours if the kidney function, as measured by an
Which precaution is most important to teach a patient who is newly prescribed sitagliptin (Januvia)?
a. Avoid caffeine while taking this drug.
b. Do not inject the drug into the same site as insulin.
c. Take a missed dose as soon as possible.
d. Report sy
C
Sitagliptin is taken just once daily. A missed dose should be taken as soon as it is remembered unless it is almost time for the next dose. It should not be taken more than once daily.
A patient who is prescribed glyburide (DiaBeta) asks if having a glass of wine once a week is okay. What is your best response?
a. "Insulin activity is dramatically reduced under the influence of alcohol, and drinking even one glass of wine will increase
D
Under normal circumstances, blood glucose levels will not be affected by moderate use of alcohol when diabetes is well controlled. When using insulin, two alcoholic beverages for men and one for women can be ingested in addition to the normal meal plan.
A patient who has been taking metformin (Glucophage) for a year is seen in the clinic and has all of the following laboratory results. Which result do you report to the prescriber immediately?
a. Blood urea nitrogen (BUN) 38 mg/dL
b. Red blood cell (RBC)
A
BUN levels are one measure of kidney health. The normal range is 10 to 20 mg/dL. An elevated BUN may indicate kidney problems or dehydration. Metformin can cause kidney problems, and the risk for lactic acidosis is increased in any patient taking metfor
Which fasting blood glucose level indicates that the antidiabetic drug prescribed for a patient with type 2 diabetes is effective at maintaining target blood glucose levels?
a. 40 mg/dL
b. 80 mg/dL
c. 120 mg/dL
d. 160 mg/dL
B
The most common target range of fasting blood glucose levels for a patient with type 2 diabetes is 70 to 110 mg/dL. The 40 mg level represents hypoglycemia, which is not the intention of therapy and can cause neurologic problems. Levels of 120 and 160 a
Which assessment precaution is most important to teach a patient who is prescribed pioglitazone (Actos) as his or her only antidiabetic drug?
a. Measure your blood glucose level about 1 hour after you take this drug.
b. Note whether you experience vivid d
ANS: D
Pioglitazone is a drug from the thiazolidinedione class. Drugs from this class are associated with heart failure. An early symptom of heart failure is fluid retention leading to weight gain. A weight gain of more than 3 lb in 1 week is an indicatio
Which signs and symptoms are associated with hypoglycemia? (select all that apply)
Warm, flushed skin
a. Shakiness, tremors
b. Increased thirst
c. Deep, rapid respirations
d. Headache
e. Glucose in the urine
f. Sensation of hunger
g. Confusion
A,D,F,G
The low blood glucose levels in the brain stimulate the autonomic nervous system and cause tremors. The brain needs glucose to survive. When blood glucose levels are low, the blood vessels in the brain dilate to allow better movement of the low le
Why are sulfonylurea oral antidiabetic drugs not recommended for women who are breastfeeding?
a. They increase the risk of the infant developing type 2 diabetes.
b. They can lower the infant's blood glucose to dangerous levels.
c. They can cause the infan
B
None of the oral antidiabetic drugs should be used by breastfeeding women because they enter the breast milk and induce side effects in the infant. Those drugs that cause hypoglycemia, such as the sulfonylureas, are especially dangerous to the infant an
A patient who has been prescribed sitagliptin (Januvia) calls the clinic and reports swelling of the face, lips, and tongue. What is your best response?
a. "Do not worry, this is a common side effect of the drug and does not require any changes."
b. "Take
D
The patient has symptoms of angioedema, an allergic reaction to the drug. The swelling can continue and eventually block the patient's airway. This is an emergency situation and the patient needs immediate attention. Once this reaction occurs with a dru
A patient who has been prescribed exenatide (Byetta) reports a weight loss of 11 lb in the last month. What is your best action?
a. Hold the next dose and contact the prescriber immediately.
b. Ask the patient to keep a daily diary of all foods eaten for
C
The actions of exenatide include reducing the sensation of hunger and slowing the rate that food leaves the stomach. Both of these actions help the patient eat less and lose weight, a desired outcome for patients with type 2 diabetes. An 11 lb weight lo