CHAPTER 33

Question 1

1. Which is a true statement about Humulin-N® insulin?
   a. It is a long-acting insulin.
   b. It is a rapid-acting insulin.
   c. It is an intermediate-acting insulin.
   d. It is given based on blood glucose levels measured before meals.

Answer 1

C

Question 2

2. What early signs of hypoglycemia should the nurse should tell the patient about?
   a. Urticaria and rash
   b. Nausea and diarrhea
   c. Irritability and confusion
   d. Fruity, acetone odour to the breath

Answer 2

C

Question 3

3. A patient has just been prescribed insulin.
   What should the nurse tell this patient to do to take the insulin correctly?
   a. Use the injection site that is the most accessible.
   b. During times of illness, increase insulin dosage by 25%.
   c. When mixing insulins, draw the cloudy insulin (such as neutral protamine
   Hagedorn [NPH] insulin) up into the syringe first.
   d. When mixing insulins, draw the clear insulin (such as regular insulin) up into the
   syringe first.

Answer 3

D

Question 4

4. Which is a true statement regarding acarbose, a glucose-elevating drug?
   a. It is also naturally synthesized by the pancreas.
   b. It is used for the treatment of hypotensive emergencies.
   c. It is only available as an α-glucosidase inhibitor.
   d. It stimulates insulin release from the pancreas.

Answer 4

C

Question 5

5. A 75-year-old patient with type 2 diabetes mellitus has recently been placed on glyburide (DiaBeta®) 10 mg daily. When is the besttime to take this medication?
   a. At night
   b. With breakfast
   c. After the midday meal
   d. Any time of day

Answer 5

B

Question 6

6. A patient who has type 2 diabetes is scheduled for a laparoscopy and has been NPO (nil per os [taking nothing by mouth]) since midnight. The patient is concerned about having to hold the medication. What is the best action for the nurse to take regarding the administration of the patient’s oral antidiabetic drug?
   a. Give the patient half the original dose.
   b. Hold all medications as ordered.
   c. Contact the physician for further orders.
   d. Give the patient the medication with a sip of water.

Answer 6

C

Question 7

7. A patient with type 2 diabetes self-administers insulin injections as part of therapy. What should the nurse tell this patient to do if she has hypoglycemia?
   a. Call the physician.
   b. Administer regular insulin.
   c. Take an oral form of glucose.
   d. Rest until the symptoms pass.

Answer 7

C

Question 8

8. The nurse is teaching a patient about self-injection of insulin.
   What should the nurse tell the patient to do regarding injection sites?
   a. Avoid the abdomen because absorption is irregular.
   b. Choose a different site at random for each injection.
   c. Give the injection in the same area each time to promote consistent absorption.
   d. Rotate sites within the same location for about 1 week before rotating to a new
   location.

Answer 8

D

Question 9

9. A patient has been prescribed a rapid-acting insulin, such as insulin lispro. What important information should the nurse give this patient about taking this type of insulin?
   a. It should be taken within 15 minutes of beginning a meal.
   b. It should be taken after the meal.
   c. Dosing is once daily at the midday meal.
   d. It is taken only in the evenings with a snack before bedtime.

Answer 9

A

Question 10

10. Six months after starting treatment for type 2 diabetes, a patient has a follow-up examination. Which laboratory test will best reflect the patient’s adherence to the antidiabetic therapy over the past few months?
    a. Hemoglobin and hematocrit levels
    b. Hemoglobin A1c level
    c. Fingerstick fasting blood glucose
    d. Serum insulin levels

Answer 10

B

Question 11

11. A patient with a history of chronic obstructive pulmonary disease (COPD) and type 2 diabetes has been treated for pneumonia for the past week. He has been receiving corticosteroids intravenously and antibiotics as part of his therapy. His pneumonia has resolved, but when the nurse monitors his blood glucose levels, his blood glucose is still elevated and he requires small amounts of sliding scale insulin coverage. What is the best explanation for this elevation?
    a. The antibiotics may have caused an increase in glucose levels.
    b. The corticosteroids may have caused an increase in glucose levels.
    c. His type 2 diabetes has converted to type 1 diabetes.
    d. The hypoxia from the COPD has caused an increased need for insulin.

Answer 11

B

Question 12

12. When should the nurse administer acarbose (Glucobay), an α-glucosidase inhibitor?
    a. Thirty minutes before breakfast
    b. With the first bite of each main meal
    c. Thirty minutes after breakfast
    d. Once daily, at bedtime

Answer 12

B

Question 13

13. A 48-year-old male patient is diagnosed with metabolic syndrome and is started on biguanide metformin (Glucophage®). He asks the nurse why he needs this drug. The nurse’s best explanation of the purpose of the metformin is that it
    a. increases the pancreatic secretion of insulin.
    b. decreases glucose production by the liver.
    c. increases intestinal absorption of glucose.
    d. decreases the pancreatic secretion of insulin.

Answer 13

B

Question 14

14. When administering morning medications for a newly admitted patient, the nurse notes that the patient has an allergy to sulfa drugs. The patient has an order for sulfonylurea gliclazide (Diamicron®). What is the best action for the nurse to take?
    a. Give the drug as ordered 30 minutes before breakfast.
    b. Hold the drug, and check the order with the physician.
    c. Give the drug and monitor for adverse effects.
    d. Give a reduced dose of the drug with breakfast.

Answer 14

B

Question 15

15. Which types of insulin can be administered intravenously?
    a. Regular insulin
    b. NPH insulin
    c. insulin glargine (Lantus®)
    d. insulin detemir (Levemir®)

Answer 15

A