Drugs for Diabetes

Understanding Pharmacology Essentials for Medication Safety

Nursing
38
Questions
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True/False
35
Choices
3
Essay
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Questions

Q1
Free

How does the glucose we eat influence metabolism?

Multiple Choice
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A) It combines with the glucose we make to form the proteins needed to replace those lost daily in stool.
B) It is composed of extra or empty calories that are not necessary for life and only contribute to obesity.
C) It is used inside cells to form the high energy substance adenosine triphosphate (ATP) needed to perform most cell functions.
D) It is converted to fats (lipids) which are used to protect the body from injury, insulate against heat loss, and provide the greatest number of needed calories.
Answer:
C) It is used inside cells to form the high energy substance adenosine triphosphate (ATP) needed to perform most cell functions.

Explanation:
Although both proteins and fats can make fuel to run the bodys actions, the main fuel provider is carbohydrate. We eat carbohydrates as sugars and starches. Once inside the digestive tract, the body converts most of the carbohydrates we eat into glucose (also called dextrose). Glucose is the most common simple carbohydrate and the main fuel for the human body. Inside cells, glucose is used to form ATP, which is the main chemical energy substance that drives all the bodys cellular reactions.
Q2
Free

What is the main role of insulin in glucose (carbohydrate) metabolism?

Multiple Choice
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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
Answer:
B) Movement of glucose from blood into the cells

Explanation:
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.
Q3
Free

What is the basic underlying pathology of diabetes mellitus?

Multiple Choice
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A) Failure of insulin production or of insulin binding to its receptors
B) Loss of the ability for insulin to convert body fat into carbohydrates or glucose
C) Inability of pancreatic insulin to break down glycogen during periods of fasting
D) Loss of the ability of pancreatic insulin to process carbohydrates for intestinal elimination, resulting in excessively high blood glucose levels
Answer:
A) Failure of insulin production or of insulin binding to its receptors

Explanation:
The lack of insulin in diabetes, either from a lack of insulin secretion or from insulin receptor pathology, prevents insulin-sensitive cells from using glucose as a fuel source needed to generate the high-energy substance adenosine triphosphate (ATP).
Q4

Why is it important to maintain normal blood glucose levels in the body?

Multiple Choice
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A) High levels increase the risk for heart disease, strokes, blindness, and kidney failure.
B) High levels increase the risk for seizure disorders, arthritis, osteoporosis, and bone fractures.
C) Low levels increase the risk for peripheral neuropathy, Alzheimers disease, and premature aging.
D) Low levels increase the risk for obesity, pancreatitis, dehydration, and certain types of cancer.
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Q5

How do diabetes type 1 and diabetes type 2 differ from each other?

Multiple Choice
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A) Diabetes type 1 develops in people under 40 years old, whereas diabetes type 2 develops only in older people.
B) Diabetes type 2 develops in people under 40 years old, whereas diabetes type 1 develops only in older people.
C) Patients with type 1 diabetes are at higher risk for obesity and heart disease, whereas patients with type 2 diabetes are at higher risk for strokes.
D) Patients with type 1 diabetes produce no insulin, whereas patients with type 2 diabetes produce insulin but their insulin receptors are not very sensitive to it.
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Q6

Why is insulin only given by injection and not as an oral drug?

Multiple Choice
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A) Injected insulin works faster than oral drugs to lower blood glucose levels.
B) Insulin is a small protein that is destroyed by stomach acids and intestinal enzymes.
C) Insulin is a high-alert drug and could more easily be abused if it were available as an oral agent.
D) Oral insulin has a high first pass loss rate in the liver and would require very high dosages to be effective.
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Q7

Which condition is the most dangerous adverse effect of insulin?

Multiple Choice
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A) Hypoglycemia
B) Hyperglycemia
C) Severe hypotension
D) Development of insulin allergy
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Q8

A patient who has been newly diagnosed with diabetes and prescribed insulin therapy asks why more than one injection of insulin each day will be required. What is the nurses best response?

Multiple Choice
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A) You need to start with multiple injections for practice until you become more proficient at self-injection.
B) A single daily dose of insulin would not match your blood insulin levels to your food intake patterns closely enough.
C) Using just one dose of insulin daily would require you to eat no more than one meal each day and you could not exercise.
D) If all your insulin were in just one injection, the dose would be too large to be absorbed predictably and you would be in danger of unexpected insulin shock.
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Q9

What is the most important action for the nurse to perform before administering a premeal short-acting insulin to a patient with type 1 diabetes?

Multiple Choice
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A) Looking up the time the long-acting insulin was administered
B) Assessing the body area in which the last insulin dose was injected
C) Checking whether the patients meal or snack is already on the unit
D) Holding the dose if the patients blood glucose level is under 110 mg/dL
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Q10

The nurse is teaching a patient about injection site selection and rotation, and how to self-inject insulin. Which statement made by the patient indicates that clarification is needed?

Multiple Choice
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A) The abdominal site is best because it is closest to the pancreas.
B) I can reach my thigh the best, so I will use different areas of the same thigh.
C) By rotating the sites within one area, my chance of having tissue damage is less.
D) If I change injection sites from the thigh to the arm, the rate the insulin is absorbed may be different.
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Q11

After gently rotating a vial of isophane insulin NPH (Humulin N), the nurse notes that the drug has a cloudy appearance. What step does the nurse take before administering it to a patient?

Multiple Choice
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A) Shaking the vial for 30 seconds before using it.
B) Placing the vial in warm water to clarify the drug.
C) Discarding the current vial and opening a new one.
D) Rechecking the dosage and drawing it into the syringe.
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Q12

Why does the nurse avoid aspirating the syringe before injecting an insulin dose?

Multiple Choice
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A) There are no blood vessels in subcutaneous tissue.
B) The needle is too thin to penetrate the wall of a vein.
C) Tissue can be damaged by pulling it into the needle.
D) Aspirating blood into the syringe affects insulin activity.
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Q13

The nurse is administering insulin by subcutaneous injection to a very thin patient. Which adjustment in injection technique does the nurse use to reduce the risk for complications?

Multiple Choice
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A) Selecting a 30-gauge needle rather than a 28-gauge needle
B) Switching the injection site to the thigh rather than the abdomen
C) Applying pressure for at least 5 minutes after removing the needle
D) Placing the needle at a 45-degree angle rather than at a 90-degree angle
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Q14

A patient is prescribed to take insulin Glargine once per day and regular insulin four times per day. The first dose of regular insulin occurs at the same time of the day as the insulin Glargine dose. Which technique does the nurse use to administer these two drugs?

Multiple Choice
expand_more
A) Drawing up and injecting the insulin Glargine first, then drawing up and injecting the dose of regular insulin.
B) Drawing up and injecting the insulin Glargine first, waiting 1 hour, then drawing up and injecting the dose of regular insulin.
C) First drawing up the dose of regular insulin, then drawing up the dose of insulin Glargine in the same syringe, followed by injecting the two insulins together.
D) First drawing up the dose of insulin Glargine, then drawing up the dose of regular insulin in the same syringe, followed by injecting the two insulins together.
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Q15

A patient who received 22 units of regular insulin an hour ago is now pale, sweaty, and has trembling hands, but is alert and able to talk. What is the nurses best first action?

Multiple Choice
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A) Prepare to administer intravenous (IV) glucose immediately.
B) Check the patients blood glucose level immediately.
C) Notify the prescriber or rapid response team immediately.
D) Give the patient a snack containing protein and a complex carbohydrate immediately.
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Q16

Which blood laboratory test result indicates to the nurse that the patient is maintaining overall good control of his or her diabetes?

Multiple Choice
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A) Hemoglobin A1c is 5.2%.
B) Ketone levels are negative.
C) Fasting blood glucose level is 88 mg/dL.
D) Glucose level immediately following a meal is 150%.
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Q17

What is the most important precaution for the nurse to teach a patient who is on insulin therapy?

Multiple Choice
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A) Avoid sharing needles with family members.
B) Do not skip meals when taking insulin.
C) Always refrigerate your insulin.
D) Avoid eating carbohydrates.
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Q18

An older patient with diabetes is visually impaired and asks if syringes can be prefilled and stored for use later. What is the nurses best response?

Multiple Choice
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A) Yes, prefilled syringes can be stored for up to 3 weeks in the refrigerator in a vertical position with the needle pointing up.
B) Yes, prefilled syringes can be stored for up to 3 weeks in the refrigerator, placed in a horizontal position.
C) Insulin reacts with plastic, so prefilled syringes must be made of glass and placed in a horizontal position.
D) No, insulin cannot be stored for any length of time outside of the container.
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Q19

A patient who has been self-injecting insulin for 10 years now has warmth, redness, and pain at the injection site. What is the nurses best action?

Multiple Choice
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A) Hold the next dose of insulin and notify the prescriber as soon as possible.
B) Teach the patient to apply ice to the area and use a different site for injection.
C) Ask how long the problem has been present and assess the patient for other symptoms of infection.
D) Document the response and reassure the patient that this is a common response that requires no action.
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Q20

Which problem associated with insulin therapy and diabetes is intensified for a patient who also is prescribed warfarin (Coumadin) or a beta adrenergic blocker?

Multiple Choice
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A) Hypoglycemia
B) Nausea and vomiting
C) Coronary artery disease
D) Risk for excessive bleeding
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Q21

Why are oral antidiabetic drugs not effective in the management of type 1 diabetes?

Multiple Choice
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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 glucose levels.
D) Patients with type 1 diabetes are more likely to have allergies to these drugs.
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Q22

How does acarbose (Precose) prevent blood glucose levels from rising too high?

Multiple Choice
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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.
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Q23

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 the nurses best action?

Multiple Choice
expand_more
A) Assess the patients blood glucose level and prepare to administer intravenous (IV) glucose.
B) Assess the patients blood glucose level and prepare to administer insulin.
C) Hold the dose and notify the prescriber immediately.
D) Administer the drug at bedtime to prevent falls.
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Q24

A patient newly diagnosed with type 2 diabetes who is prescribed rosiglitazone (Avandia) has all the following health problems. For which problem does the nurse check with the prescriber to make certain rosiglitazone is an appropriate drug choice?

Multiple Choice
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A) Severe asthma for the last 3 years
B) Myocardial infarction 1 year ago
C) Uncontrolled hypertension
D) Glaucoma
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Q25

Which blood laboratory test result is most important for the nurse to check before administering the first prescribed dose of miglitol (Glyset) to a patient?

Multiple Choice
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A) International normalized ratio (INR)
B) Blood urea nitrogen (BUN) level
C) White blood cell (WBC) count
D) Lactate dehydrogenase
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Q26

What precaution does the nurse teach a patient who is prescribed to take an oral sulfonylurea agent to maintain control of blood glucose levels?

Multiple Choice
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A) Change positions slowly.
B) Stop taking this drug at the first sign of an infection.
C) Avoid taking nonsteroidal anti-inflammatory drugs.
D) Do not skip a dose of the drug even if you are unable to eat.
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Q27

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 the nurses best response?

Multiple Choice
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A) Glucovance is a new oral insulin.
B) Your diabetes is better and only one drug is needed.
C) This new drug is more effective than either glyburide or metformin.
D) Glucovance contains a combination of both glyburide and metformin.
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Q28

A patient with type 2 diabetes is prescribed nateglinide (Starlix). Which statement indicates to the nurse that the patient has a correct understanding of this therapy?

Multiple Choice
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A) I will try not to chew or break this tablet.
B) For best results, I need to take this drug right before I eat.
C) If this drug causes nausea, I will take it just before I go to bed.
D) If I miss a meal, I will take this drug anyway at its regularly scheduled time.
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Q29

A patient who is prescribed glyburide (DiaBeta) asks if having a glass of wine once a week is okay. What is the nurses best response?

Multiple Choice
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A) Insulin activity is dramatically reduced under the influence of alcohol, and drinking even one glass of wine will increase your insulin requirements.
B) Diabetes reduces your kidney function, so you should avoid ingesting alcohol in all forms at all times.
C) You should not drink any alcohol as it is likely to increase your sense of hunger and make you overeat.
D) One glass of wine can be ingested with a meal on occasion and cause no problems.
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Q30

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 does the nurse report to the prescriber immediately?

Multiple Choice
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A) Blood urea nitrogen (BUN) 38 mg/dL
B) Red blood cell (RBC) count 4.1 million/mm3
C) Random blood glucose level 135 mg/dL
D) Alkaline phosphatase 40 international units per liter
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Q31

Which fasting blood glucose level indicates to the nurse that the antidiabetic drug that has been prescribed for a patient with type 2 diabetes is effective at maintaining target blood glucose levels?

Multiple Choice
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A) 40 mg/dL
B) 80 mg/dL
C) 120 mg/dL
D) 160 mg/dL
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Q32

Which assessment precaution is most important for the nurse to teach a patient who is prescribed pioglitazone (Actos) as his or her only antidiabetic drug?

Multiple Choice
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A) Measure your blood glucose level about 1 hour after you take this drug.
B) Note whether you experience vivid dreams or nightmares.
C) Check your urine daily for a pinkish color.
D) Weigh yourself daily and keep a record.
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Q33

Why are sulfonylurea oral antidiabetic drugs not recommended for women who are breastfeeding?

Multiple Choice
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A) They increase the risk of the infant developing type 2 diabetes.
B) They can lower the infants blood glucose to dangerous levels.
C) They can cause the infant to develop an allergy to sulfa drugs.
D) They are not eliminated by the infants immature intestinal system.
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Q34

A patient who has been prescribed sitagliptin (Januvia) calls the clinic and reports swelling of the face, lips, and tongue. What is the nurses best response?

Multiple Choice
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A) Do not worry, this is a common side effect of the drug and does not require any changes.
B) Take only half the drug dose and see the prescriber within the next week.
C) Apply cold compresses to the affected areas and take an aspirin.
D) Stop taking the drug and call 911.
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Q35

A patient who has been prescribed exenatide (Byetta) reports a weight loss of 11 lb in the last month. What is the nurses best action?

Multiple Choice
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A) Hold the next dose and contact the prescriber immediately.
B) Ask the patient to keep a daily diary of all foods eaten for the next month.
C) Reassure the patient that this is an expected effect of the drug and no action is needed.
D) Instruct the patient to skip one dose of the drug per day and increase his or her daily calories.
Answer:

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Q36

[Sequencing] A patient is to receive 15 units of NPH insulin and 20 units of regular insulin in the same syringe. In what order does the nurse perform the steps to prepare this injection?
A. Make sure the syringe is free from air bubbles.
B. Check the syringe for a volume of insulin that is 35 units.
C. Clean the rubber stoppers of each bottle with separate alcohol swabs.
D. Check to make sure the concentration and types of insulin are correct.
E. Draw up 20 units of air and inject it into the regular insulin (short-acting insulin) bottle with the bottle in its normal, upright position.
F. Draw up 15 units of air and inject it into the NPH bottle with the bottle in its normal, upright position.
G. Place the same needle with the syringe attached into the NPH bottle, invert the bottle, and withdraw 15 units of NPH insulin into the same syringe with the regular insulin.
H. Without removing the needle, turn the bottle upside down and withdraw 20 units of regular insulin, then withdraw the needle from the bottle.

Essay
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Q37

[Sequencing] A patient is to receive 15 units of NPH insulin and 20 units of regular insulin in the same syringe. In what order does the nurse perform the steps to prepare this injection?
A. Make sure the syringe is free from air bubbles.
B. Check the syringe for a volume of insulin that is 35 units.
C. Clean the rubber stoppers of each bottle with separate alcohol swabs.
D. Check to make sure the concentration and types of insulin are correct.
E. Draw up 20 units of air and inject it into the regular insulin (short-acting insulin) bottle with the bottle in its normal, upright position.
F. Draw up 15 units of air and inject it into the NPH bottle with the bottle in its normal, upright position.
G. Place the same needle with the syringe attached into the NPH bottle, invert the bottle, and withdraw 15 units of NPH insulin into the same syringe with the regular insulin.
H. Without removing the needle, turn the bottle upside down and withdraw 20 units of regular insulin, then withdraw the needle from the bottle.

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Q38

A patient is prescribed repaglinide (Prandin) 3 mg. The drug available is repaglinide 0.5 mg per tablet. How many tablets does the nurse administer to the patient? _____ tablet(s)

Essay
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