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fundamentals pharmacology > Diabetes/Insulin > Flashcards

Diabetes/Insulin Flashcards

1
Q

The nurse is admitting a patient w/ type 2 diabetes. The nurse should expect the following symptoms during an assessment EXCEPT

A) Hypoglycemia
B) Frequent bruising
C) Ketonuria
D) Dry mouth

A

A) Hypoglycemia

B/C - Hypoglycemia does not occur in type 2 diabetes unless the patient is on insulin therapy or other medications.

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2
Q

What does an A1C test measure?

A

Average blood glucose control of an individual over the previous three months.

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3
Q

What is an acceptable A1C?

A

<6.7%

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4
Q

Rotation sites for insulin injections should be separated from one another by 1 inch and should be used only every…

A) Third day
B) Every other day
C) 1-2 weeks
D) 2-4 weeks

A

C) 1-2 weeks

B/C it may cause lumps or scarred tissue to form under the skin and interfere w/ insulin absorption

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5
Q

What symptom distinguishes a hypoglycemic reaction from a ketoacidosis reaction?

A) Blurred vision
B) Diaphoresis
C) Nausea
D) Weakness

A

B) Diaphoresis

B/C the symptoms of hypoglycemia are “Cold & clammy give me some candy”, pallor, irritability, hunger, lack of coordination, sleepy

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6
Q

Patho of type 1 diabetes

A

Kills pancreatic beta cells = no insulin production

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7
Q

Complication of type 1 diabetes

A

Diabetic ketoacidosis

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8
Q

Treatment of T1DM

A

Insulin therapy

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9
Q

Symptoms of diabetic ketoacidosis (DKA) include

A

1) Nausea/vomiting
2) Fruity breath
3) Dry mouth
4) Kussmaul respirations
5) Glucose >250
6) Ketones in urine

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10
Q

Treatment of DKA

A

1) Maintain airway/O2
2) IV fluids (Normal saline & insulin drip)

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11
Q

What should the nurse monitor with DKA?

A

1) ECG, oxygen sats, urine output (dehydration)
2) Breath sounds
3) Glucose & potassium

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12
Q

Complication of T2DM

A

Hyperosmolar Hyperglycemia Syndrome (HHS) -

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13
Q

Symptoms of HHS

A
  • Cognitive impairment
  • Polyuria (excessive urination)
  • Drowsy, coma, seizure
  • BS >600
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14
Q

Treatment of HHS

A
  • IV Insulin
  • Saline
  • Monitor I/Os closely
  • Monitor lab values
  • Monitor cardiac function
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15
Q

The 3 P’s of T1DM

A

1) Polydipsia (Excessive thirst)
2) Polyphagia (Excessive hunger)
3) Polyuria (Excessive urination)

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16
Q

Rapid Insulins - Rapid Acting GAL

A

1) Glulisine (Apidra)
2) Aspart (Novolog)
3) Lispro (Humolog)

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17
Q

What is the onset of rapid acting insulins?

A

15-30 minutes

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18
Q

How long do rapid acting insulins last?

A

4 hours

19
Q

When should you take rapid acting insulins?

A

0-15 minutes before a meal

20
Q

Short Acting insulins (Regular)

A

Humulin Regular
Novolin Regular

21
Q

When do regular insulins start to work?

A

30 minutes - 1 hour

22
Q

How long do short acting (regular) insulins last?

A

8 hours

23
Q

When should you take short acting (regular) insulins?

A

30 minutes before a meal

24
Q

What are NPH insulins?

A

Humulin
Novolin

25
Q

When do NPH insulins start to work?

A

2-4 hours

26
Q

How long do NPH insulins last?

A

12 hours

27
Q

What are long acting insulins?

A

1) Glargine (Lantus)
2) Detemir (Levemir)

28
Q

When do long acting insulins start to work?

A

1-2 hours

29
Q

How long do long acting insulins last?

A

24 hours

30
Q

A nurse is providing a bedtime snack for his patient. This is based on the knowledge that intermediate acting insulins are effective for an approximate duration of…

A) 6-8 hours
B) 10-14 hours
C) 14-18 hours
D) 24-28 hours

A

C) 14-18 hours

B/C Intermediate acting insulins (NPH) include Humulin & Novolin. They have an onset of 2-4 hours, peak of 4-12, and duration of 14-18.

31
Q

A nurse went into a patient’s room to do routine vital signs and found that the patient’s bedtime snack was not eaten. This should alert the nurse to check and assess for

A) Elevated serum bicarbonate & decreased blood pH
B) Signs of hypoglycemia earlier than expected
C) Symptoms of hyperglycemia during the peak time of NPH insulin
C) Sugar in the urine

A

B) Signs of hypoglycemia earlier than expected

B/C a bedtime snack can prevent blood sugar levels from dropping very low during the night

32
Q

The client is taking NPH insulin daily every morning. The nurse instructs the client that the most likely time for a hypoglycemia reaction to occur is

A) 2-4 hours after admin
B) 6-14 hours after admin
C) 16-18 hours after admin
D) 18-24 hours after admin

A

B) 6-14 hours after admin

B/C the peak time of insulin is the time it is working the hardest. NPH insulin is an intermediate acting insulin that has an onset of 2-4 hours, peaks at 4-12, and effective for 14-18 hours.

33
Q

A client w/ DKA is being treated in the ER. Which finding would a nurse expect to note as confirming this diagnosis?

A) Elevated blood glucose level and low plasma bicarbonate
B) Decreased urine output
C) Increased RR & pH
D) Comatose state

A

A) Elevated blood glucose level & low plasma bicarbonate

B/C in DKA blood glucose will be >250 and plasma bicarb will be <15mEq/L, & ketones will be present in blood and urine

34
Q

A client with DM demonstrates acute anxiety when first admitted for the treatment of hyperglycemia. The MOST appropriate intervention to decrease the patient’s anxiety would be to

A) Administer a sedative
B) Make sure the client knows all the correct medical terms to understand what is happening
C) Ignore them
D) Convey empathy, trust, & respect toward the client

A

D) Convey empathy, trust, & respect toward the client

35
Q

A nurse is caring for a client admitted to the ER with DKA. In the acute phase the PRIORITY nursing action is to prepare to

A) Administer regular insulin IV
B) Administer 5% dextrose IV
C) Correct the acidosis
D) Apply an ECG monitor

A

A) Administer regular insulin IV

B/C lack of insulin causes DKA (Type 1)

36
Q

A nurse performs a physical assessment on a client with T2DM. Findings include fasting glucose of 120, temp of 101, pulse of 88, RR of 22, BP of 140/84. Which finding would be of the MOST concern to the nurse?

A

Temperature of 101

B/C Elevated temp may indicate infection & infection is the leading cause of HHS (T2DM)

37
Q

A client with T1DM calls the nurse to report recurrent episodes of hypoglycemia w/ exercise. Which statement by the client indicated an inadequate understanding of the peak action of NPH insulin & exercise?

A) The best time for me to exercise is every afternoon
B) The best time for me to exercise is right after I eat
C) The best time for me to exercise is after breakfast
D) The best time for me to exercise is after my morning snack

A

A) The best time for me to exercise is every afternoon

B/C hypoglycemic reaction may occur in response to increased exercise. Patients should avoid exercise during the peak time of insulin. NPH insulin peaks at 6-14 hours

38
Q

When a client is first admitted w/ HHS the nurse’s PRIORITY is to provide

A) Oxygen
B) Carbohydrates
C) Fluid replacement
D) Dietary instruction

A

C) Fluid replacement

B/C the first action of treatment for HHS is to rehydrate the patient with fluids and give insulin

39
Q

When a patient is experiencing DKA what kind of insulin should be administered?

A) NPH
B) Regular
C) Lispro injection
D) Glargine injection

A

B) Regular

B/C Humulin (Regular insulin) is a short acting insulin and is administered via IV which will improve the patient’s condition faster

40
Q

A 44-year-old woman with type 1 diabetes comes to the emergency department due to abdominal pain accompanied by nausea and vomiting. The patient had a history of chronic back pain due to a motor accident 20 years ago. Her situation renders her unable to work and pay for the increasing price of insulin, which has doubled during the last five years. The patient doesn’t have medical coverage or insurance; therefore, she rations her insulin intake, making her unable to follow her prescribed therapeutic regimen for her diabetes. Because of her situation, the client is at high risk of developing diabetic ketoacidosis. As her nurse, which of the following symptoms would you anticipate the client to exhibit? Select all that apply.

A) Fruity odor breath
B) Deep & labored respirations
C) Blurred vision
D) Increased urination
E) Increased thirst
F) Fatigue
G) Glucose level of 60
H) Dehydration
I) Respiratory rate of 8
J) Hypernatremia
K) Metabolic alkalosis

A

A) Fruity breath
B) Deep & labored respirations
C) Blurred vision
D) Increased urination
E) Increased thirst
F) Fatigue
H) Dehydration

B/C these are symptoms of DKA

41
Q

What are rapid acting insulins and what are they used for?

A

Glulisine, Aspart, Lispro - they are used to prevent blood sugar spikes that can happen after eating

42
Q

What are short acting insulins and what are they used for?

A

Humulin & Novolin Regular - help reduce blood glucose at mealtimes

43
Q

What are NPH and long acting insulins and what are they used for?

A

NPH - Humulin & Novolin
Long - Glargine & Detemir

They are used for managing the body’s general needs

fundamentals pharmacology (11 decks)

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