Chapter 18 Flashcards
(27 cards)
What is the main role of insulin in the body?
a. Conversion of complex carbohydrates into glucose
b. Movement of glucose from blood into the cells
c. Prevention of kidney excretion of glucose
d. Prevention of the formation of fat cells
ANS: B
Many body cells have membranes that do not allow glucose to move into the cells to
participate in metabolism. When insulin binds to membrane insulin receptors, the
membranes become more open to glucose, allowing it to enter.
In what way does insulin work to lower blood glucose levels?
a. Enhancing the enzymes that break down glucose
b. Helping glucose to move from the blood into cells
c. Converting glucose into proteins in the liver and brain
d. Converting glycogen into glucose in the liver and brain
ANS: B
When insulin binds to insulin receptors on cells, the cells’ membranes become more open
(permeable) to glucose and glucose transport proteins in the cell membranes become more
active. The overall result is movement of glucose into the cells, which lowers blood glucose
levels.
Which term means an elevated blood sugar (glucose) level?
a. Glycogen
b. Euglycemia
c. Hypoglycemia
d. Hyperglycemia
ANS: D
Glycogen is a stored form of human carbohydrate. Euglycemia means a blood sugar level
within the normal range. Hypoglycemia is a lower than normal blood sugar level.
Which hormone has an action opposite to the action of insulin?
a. Glycogen
b. Glucagon
c. Hemoglobin A1c
d. Adenosine triphosphate
ANS: B
Glucagon, which is known as the hormone of starvation, is secreted from the alpha cells of
the pancreas when blood glucose levels are lower than normal. Glucagon goes to the liver
and triggers the breakdown of glycogen and release of glucose into the blood, raising the
blood glucose level. These actions are exactly the opposite of insulin’s actions.
What is the main reason that insulin is needed as drug therapy for people who have type 1
diabetes?
a. The beta cells of the pancreas no longer make insulin.
b. The alpha cells of the pancreas no longer make insulin.
c. The beta cells of the pancreas make too much glucagon.
d. The alpha cells of the pancreas make too much glucagon.
ANS: A
With type 1 diabetes, the beta cells of the pancreas are destroyed and no longer produce any
insulin. Insulin is necessary for life, so drug therapy for type 1 diabetes requires insulin.
People who have type 2 diabetes often continue to secrete insulin from their beta cells; thus
extra insulin may not be needed. Drugs for this condition often work by forcing the beta
cells to release the patient’s own insulin.
- Which statement regarding diabetes mellitus (DM) type 2 is true?
a. Some people with DM type 2 will need insulin.
b. This type of diabetes is found in children less than 1 year of age.
c. Drug therapy for DM type 2 eliminates the need for diet and exercise.
d. DM type 2 is characterized by sudden, complete shutdown of the pancreas.
ANS: A
Insulin may also be necessary for some people with DM type 2, although diet, weight
reduction, and noninsulin antidiabetic drugs are often effective in maintaining good blood
glucose control.
You are preparing to discuss a newly prescribed insulin stimulator with a patient. What
condition would need to be present for this drug to work effectively for a diabetic patient?
a. The patient would need to be able to self-inject the drug.
b. The patient would need to be in ketoacidosis to begin this drug.
c. The patient would need to have diabetes mellitus type 2 to use this drug.
d. The patient needs to have some functioning beta cells for this drug to work.
ANS: C
Insulin stimulators are oral drugs that lower blood glucose levels by stimulating the release
of insulin stored in the beta cells of the pancreas. Therefore the patient must have some
functioning beta cells if these drugs are to work.
A patient with diabetes mellitus type 2 is prescribed glipizide (Glucotrol). Which of the
following nursing actions would be the best action when giving this drug?
a. Give this drug with milk.
b. Give this drug with a meal.
c. Assess the patient for signs of pancreatitis.
d. Take the patient’s pulse before giving this drug.
ANS: B
These drugs with, or just before, meals prevent hypoglycemia. If you must skip a meal, also
skip the drug dose.
Which oral antidiabetic drug belongs to the biguanide class?
a. Acarbose (Precose)
b. Nateglinide (Starlix)
c. Pioglitazone (Actos)
d. Metformin (Glucophage)
ANS: D
There is only one drug in the biguanide class, and it is metformin.
For which patient would a biguanide antidiabetic drug be contraindicated?
a. A female patient who is pregnant
b. A newly diagnosed type 2 diabetic
c. A patient with known kidney disease
d. A diabetic patient with some functioning pancreatic beta cells
ANS: C
Metformin should not be given to patients with kidney disease as it can cause kidney failure.
A patient taking metformin (Glucophage) is scheduled for a radiographic scan with contrast
dye. What instructions should you provide to this patient?
a. “Take the metformin as soon as the scan is completed.”
b. “Stop taking the metformin at least 24 h before your scan.”
c. “Stop taking the metformin for 3 days before and after the scan.”
d. “Take your metformin the night before the scan, and resume after the test is
completed.”
ANS: B
Metformin is to be stopped at least 24 h before radioactive dye is used and not started again
until 48 h after the test is completed.
You are teaching a patient prescribed rosiglitazone about this drug. Which statement should
you include in the patient’s teaching plan?
a. “Call if you develop swelling of the legs, or weight gain.”
b. “If you miss a dose of this drug, take two tablets for your next dose.”
c. “You will not need to check your blood sugar when using this drug.”
d. “Vision changes are expected with this drug, and are not of a concern.”
ANS: A
The thiazolidinediones have been associated with severe cardiovascular side effects and
must be used with care. Rosiglitazone can also cause fluid retention, liver problems, and
macular edema. Teach patients to report swelling of the feet or ankles, or rapid weight gain
to the healthcare provider.
Which precaution is most important to teach patients who have any type of diabetes about
alcohol use?
a. “Be sure to take your antidiabetic drug or drugs 15 min before drinking any
alcohol.
b. “Only drink alcohol right before bedtime because it will make you drowsy.”
c. “Increase your water intake whenever you drink alcohol.”
d. “Only drink alcohol with a meal or shortly after a meal.”
ANS: D
Drinking alcoholic beverages leads to hypoglycemia. To prevent hypoglycemia, alcohol
consumption should be limited to no more than one serving per day and should be taken
either with a meal or very shortly after a meal.
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 the binding of insulin to its membrane receptors.
d. It releases more insulin from pancreatic beta cells.
ANS: 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 not rise as far or
as fast after a meal.
You are about to give miglitol (Glyset) to a patient with diabetes mellitus type 2. Which
nursing action is most important for this patient?
a. Rotate the injection site on a weekly basis.
b. Give this drug with the first bite of a meal.”
c. Do not mix this drug in the same syringe as insulin.
d. Assess the patient for signs and symptoms of heart failure.
ANS: 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.
Which complaint by a patient taking a DPP-4 inhibitor would alert you to a potential
complication from this drug?
a. Diarrhea
b. Abdominal pain
c. Nasopharyngitis
d. Swelling of the lower extremities
ANS: B
Symptoms of acute pancreatitis include: upper abdominal radiating to the back, nausea and
vomiting, fever, rapid pulse, and should be reported to the healthcare provider immediately,
as this is a serious adverse effect of the drug.
A young, female patient with diabetes mellitus who is taking an oral antidiabetic drug comes
in for a regularly scheduled clinic appointment. She tells you that is currently taking an oral
contraceptive agent for birth control. What is your best response?
a. “Oral contraceptives are contraindicated for diabetics.”
b. “Oral contraceptives can be taken only if you are on insulin.”
c. “Oral contraceptives can be safely taken with oral antidiabetic agents.”
d. “Oral contraceptives reduce their effectiveness of oral antidiabetic agents.”
ANS: D
Oral contraceptives and antibiotics can interact with drugs for diabetes, reducing their
effectiveness.
You are teaching a patient who has been prescribed a sodium-glucose cotransport inhibitor
for the treatment of diabetes mellitus type 2. The patient asks you to explain how this drug
works. What is your best response?
a. “This drug works by inactivating normal gut hormones.”
b. “This drug works by preventing the kidney from reabsorbing glucose.”
c. “This drug works by making insulin receptors more sensitive to insulin.”
d. “This drug works by preventing enzymes from breaking down starches into
glucose.”
ANS: B
Sodium-glucose cotransport inhibitors are a new category of noninsulin antidiabetic drug
that lower blood glucose levels by preventing the kidney from reabsorbing glucose that was
filtered from the blood into the urine. This glucose then remains in the urine and is excreted
rather than moved back into the blood.
A patient who is taking dapagliflozin (Farxiga) for diabetes mellitus type 2 has also been
prescribed furosemide (Lasix) for another condition. What potential risk should you monitor
for on this patient?
a. Risk for infection
b. Risk for bleeding
c. Risk of dehydration
d. Risk for fluid retention
ANS: C
Combining sodium-glucose cotransport inhibitors with diuretics increases the frequency of
urination increases and can result in dehydration.
A patient is taking a sodium-glucose cotransport inhibitor for the treatment of diabetes.
Which of the following laboratory values should you monitor in this patient?
a. Serum potassium
b. Serum amylase and lipase
c. Hemoglobin and hematocrit
d. Cholesterol and triglycerides
ANS: A
Patients with diabetes are at increased risk for hyperkalemia due to the presence of renal
impairment, and potential use of diuretics and antihypertensives used in this population.
Hyperkalemia is also potential serious adverse effect of sodium-glucose cotransport
inhibitors. Monitor the patient’s serum potassium level, and check for symptoms of
hyperkalemia (muscle twitching, numbness and tingling, irregular heart rate).
A patient is started on exenatide (Byetta), an injectable incretin mimetic. The patient asks
you how this drug will help lower blood glucose. Which is your best response?
a. “This drug restores insulin secretion.”
b. “This drug increases insulin secretion.”
c. “This drug works to increase the duration of insulin.”
d. “This drug works by increasing the action of glucagon.”
ANS: B
Incretin mimetics act like the natural gut hormones (e.g., GLP-1) secreted in response to
food in the stomach, increasing insulin secretion, decreasing glucagon secretion, and
slowing the rate of gastric emptying. This results in an increase in insulin secretion, a
decrease in glucagon secretion, and a slower the rate of gastric emptying.
A patient is taking insulin each morning. When the insulin peaks, the patient should be
observed for which signs of hypoglycemia?
a. Tachycardia and acetone breath
b. Nervousness, hunger, weakness, pallor, and confusion
c. Tachycardia, loss of consciousness, and Kussmaul respirations
d. Serum glucose greater than 150 mg/dL hunger, and confusion
ANS: B
Symptoms of hypoglycemia include nervousness; hunger; weakness; cold, clammy skin;
and change in the level of consciousness.
Which condition is the most dangerous adverse effect of insulin?
a. Hypoglycemia
b. Hyperglycemia
c. Severe hypotension
d. Development of insulin allergy
ANS: A
The main adverse effect of insulin is the lowering of blood glucose levels below normal
(hypoglycemia). This response, also called insulin shock, is dangerous because brain cells
are very sensitive to low blood glucose levels and the patient can become nonresponsive
very quickly. If the problem is not corrected immediately, the patient can die or have
irreversible brain damage.
What makes insulin a “high-alert” drug?
a. Many people are very allergic to insulin.
b. Serious harm can occur if the wrong dose is given.
c. If too much insulin is given, the respiratory system is depressed.
d. If too much insulin is given, the blood glucose level could climb to dangerously
high levels.
ANS: B
Insulin as a drug works very quickly. Great harm can come to a patient who receives it and
does not have diabetes. Also, if too much of it is given to a patient who does have diabetes,
the patient can become severely hypoglycemic and die. If too little insulin is given to a
patient who has diabetes, blood glucose levels remain too high and cause organ damage.
