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Chapter 28: Diabetic Drugs

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Chapter 28: Diabetic Drugs

14 problems · 0 figures

Case Study 28.1.1 §28.1 source ↗

Read the following clinical scenario to answer the questions that follow. This case will evolve throughout the chapter.

Alaina Sanders is a 65-year-old client who presented to her health care provider’s office reporting fatigue, an increase in urination, feeling thirsty all the time, and blurred vision for the past 3 months.

History
Hyperlipidemia
Hypertension
Does not exercise or follow a special diet

Current Medications
Atorvastatin 20 mg once daily
Amlodipine 10 mg once daily

After reviewing the client’s symptoms, the nurse anticipates which diagnosis by the health care provider?
  1. a.
    Gestational diabetes
  2. b.
    Type 1 diabetes
  3. c.
    Type 2 diabetes
  4. d.
    Hypoglycemia
Table 28.1 in the book ↗
Vital Signs Physical Examination
Temperature: 97.8°F

• Head, eyes, ears, nose, throat (HEENT): Within normal limits

• Cardiovascular: No jugular vein distention or peripheral edema noted. S1, S2 heard on auscultation.

• Respiratory: Clear to auscultation bilaterally

• GI: Abdomen soft, nontender, nondistended

• GU: See history of present illness (HPI)

• Neurological: Within normal limits

• Integumentary: No wounds noted. Skin appropriate for age.
Blood pressure: 102/74 mm Hg
Heart rate: 78 beats/min
Respiratory rate: 20 breaths/min
Oxygen saturation: 95% on room air
Height: 5'5"
Weight: 188 lb

Answer

C. Type 2 diabetes
Due to the client’s age, gradual onset of symptoms and sedentary lifestyle, she will most likely be diagnosed with type 2 diabetes mellitus. This client’s symptoms of fatigue, polyuria, thirst, and blurred vision are consistent with this diagnosis.

Case Study 28.1.2 §28.1 source ↗

Read the following clinical scenario to answer the questions that follow. This case will evolve throughout the chapter.

Alaina Sanders is a 65-year-old client who presented to her health care provider’s office reporting fatigue, an increase in urination, feeling thirsty all the time, and blurred vision for the past 3 months.

History
Hyperlipidemia
Hypertension
Does not exercise or follow a special diet

Current Medications
Atorvastatin 20 mg once daily
Amlodipine 10 mg once daily

To determine the client’s blood glucose level over the last 3 months, which diagnostic test does the nurse anticipate the health care provider will order?
  1. a.
    Complete blood count
  2. b.
    Random blood glucose
  3. c.
    Fasting blood glucose
  4. d.
    Glycosylated hemoglobin (hemoglobin A1c)
Table 28.1 in the book ↗
Vital Signs Physical Examination
Temperature: 97.8°F

• Head, eyes, ears, nose, throat (HEENT): Within normal limits

• Cardiovascular: No jugular vein distention or peripheral edema noted. S1, S2 heard on auscultation.

• Respiratory: Clear to auscultation bilaterally

• GI: Abdomen soft, nontender, nondistended

• GU: See history of present illness (HPI)

• Neurological: Within normal limits

• Integumentary: No wounds noted. Skin appropriate for age.
Blood pressure: 102/74 mm Hg
Heart rate: 78 beats/min
Respiratory rate: 20 breaths/min
Oxygen saturation: 95% on room air
Height: 5'5"
Weight: 188 lb

Answer

D. Glycosylated hemoglobin (hemoglobin A1c)
Glycosylated hemoglobin measures the average blood glucose level of an individual for the past 90 days. A reading of 6.5% or higher indicates diabetes.

Case Study 28.3.3 §28.3 source ↗

Read the following clinical scenario to answer the questions that follow. This case study is a follow-up to Case Study Part A.

Alaina Sanders was diagnosed with type 2 diabetes, and the health care provider prescribed extended-release glipizide 5 mg orally and lifestyle modifications. The client returns to her health care provider’s office today for a 6-month follow-up appointment after starting drug treatment and lifestyle modifications.

Laboratory Results
Glycosylated hemoglobin

6 Months Ago
7.8%

Today
6.9%

Which statement by the client indicates to the nurse that Alina understands her treatment plan?
  1. a.
    “I take extended-release glipizide with my breakfast.”
  2. b.
    “I take extended-release glipizide with dinner.”
  3. c.
    “I chew my extended-release glipizide tablet.”
  4. d.
    “I should watch for hyperglycemia while taking extended-release glipizide.”
Table 28.6 in the book ↗
Vital Signs Physical Examination
Temperature: 97.4°F

• Head, eyes, ears, nose, throat (HEENT): Within normal limits

• Cardiovascular: No jugular vein distention or peripheral edema. S1, S2 heard on auscultation.

• Respiratory: Breath sounds clear bilaterally

• GI: Abdomen soft, nontender, nondistended

• GU: Within normal limits

• Neurological: Within normal

• Integumentary: No wounds noted; skin appropriate for age
Blood pressure: 108/72 mm Hg
Heart rate: 84 beats/min
Respiratory rate: 18 breaths/min
Oxygen saturation: 97% on room air
Height: 5'5"
Weight: 173 lb

Answer

A. “I take extended-release glipizide with my breakfast.”
Extended-release glipizide should be taken with the first meal of the day, not with dinner.

Case Study 28.3.4 §28.3 source ↗

Read the following clinical scenario to answer the questions that follow. This case study is a follow-up to Case Study Part A.

Alaina Sanders was diagnosed with type 2 diabetes, and the health care provider prescribed extended-release glipizide 5 mg orally and lifestyle modifications. The client returns to her health care provider’s office today for a 6-month follow-up appointment after starting drug treatment and lifestyle modifications.

Laboratory Results
Glycosylated hemoglobin

6 Months Ago
7.8%

Today
6.9%

Based on the client’s glycosylated hemoglobin results, which treatment plan does the nurse anticipate the health care provider will prescribe?
  1. a.
    No changes to the treatment plan
  2. b.
    Increase glipizide to 10 mg daily
  3. c.
    Change to another oral diabetic drug
  4. d.
    Add insulin lispro 6 units daily
Table 28.6 in the book ↗
Vital Signs Physical Examination
Temperature: 97.4°F

• Head, eyes, ears, nose, throat (HEENT): Within normal limits

• Cardiovascular: No jugular vein distention or peripheral edema. S1, S2 heard on auscultation.

• Respiratory: Breath sounds clear bilaterally

• GI: Abdomen soft, nontender, nondistended

• GU: Within normal limits

• Neurological: Within normal

• Integumentary: No wounds noted; skin appropriate for age
Blood pressure: 108/72 mm Hg
Heart rate: 84 beats/min
Respiratory rate: 18 breaths/min
Oxygen saturation: 97% on room air
Height: 5'5"
Weight: 173 lb

Answer

A. No changes to the treatment plan
The client’s glycosylated hemoglobin has dropped from 7.8% to 6.9%, below the goal of less than 7% for a person with diabetes. She has also lost 15 pounds in 6 months. The health care provider would not recommend changes in the treatment plan at this time.

28-1 §28.RQ source ↗

A nurse is assessing a client for type 1 diabetes. Which of the following findings should the nurse expect if the client does, in fact, have diabetes?
  1. a.
    Hemoglobin A1c 5.6%
  2. b.
    Fasting blood glucose 101 mg/dL
  3. c.
    Random blood glucose 150 mg/dL
  4. d.
    Glycosylated hemoglobin 6.8%

Answer

D. Glycosylated hemoglobin 6.8%
A glycosylated hemoglobin greater than 6.5% represents diabetes.

28-2 §28.RQ source ↗

A nurse is developing an education plan for a client with diabetes in regard to an insulin pump. Which of the following should the nurse include in the education plan?
  1. a.
    Teach the client to rotate sites for insulin injections
  2. b.
    Teach the client to recognize symptoms of hypoglycemia
  3. c.
    Teach the client how to administer insulin injections
  4. d.
    Teach the client how to obtain a glycosylated hemoglobin once a month

Answer

B. Teach the client to recognize symptoms of hypoglycemia
Clients with diabetes should be taught to recognize signs of hypoglycemia to prevent a hypoglycemic reaction and serious complications.

28-3 §28.RQ source ↗

A nurse is administering regular insulin to a client with diabetes. After administering the correct dose at 6:30 a.m., the nurse should ensure the client receives breakfast at which of the following times?
  1. a.
    7 a.m.
  2. b.
    8 a.m.
  3. c.
    9 a.m.
  4. d.
    10 a.m.

Answer

A. 7 a.m.
The onset of regular insulin is 30 minutes. Breakfast should be given by 7 a.m. to prevent hypoglycemia.

28-4 §28.RQ source ↗

A nurse is caring for a client with type 1 diabetes who is being prescribed a long-acting insulin. The nurse identifies which of the following as a long-acting insulin?
  1. a.
    Insulin lispro
  2. b.
    Insulin glargine
  3. c.
    Human regular insulin
  4. d.
    Insulin isophane NPH

Answer

B. Insulin glargine
Insulin glargine is a long-acting insulin.

28-5 §28.RQ source ↗

A nurse is teaching a client with diabetes about a new prescription for insulin isophane NPH. Which of the following instructions should the nurse include in the teaching?
  1. a.
    Discard the insulin isophane NPH if cloudy.
  2. b.
    Take insulin isophane NPH 15 minutes before meals.
  3. c.
    Eat a snack 7 hours after taking the insulin isophane NPH.
  4. d.
    Rotate insulin isophane NPH injection sites once a week.

Answer

C. Eat a snack 7 hours after taking the insulin isophane NPH.
Insulin isophane NPH peaks in 4–12 hours. The client is at risk for hypoglycemia during this time and should eat a snack to prevent hypoglycemia.

28-6 §28.RQ source ↗

A nurse is caring for a client with diabetes who has a blood glucose of 50 mg/dL and is semiconscious and having difficulty swallowing. Which of the following actions should the nurse take?
  1. a.
    Administer a routine dose of glyburide
  2. b.
    Administer 15 grams of carbohydrates
  3. c.
    Give the client a glass of orange juice
  4. d.
    Administer glucagon

Answer

D. Administer glucagon
Glucagon is used to treat severe hypoglycemia when the client is semiconscious, unconscious, or unable to consume carbohydrates/sugar.

28-7 §28.RQ source ↗

A nurse is preparing to administer 15 units of regular insulin and 23 units of NPH insulin subcutaneously. What is the total number of units of insulin that the nurse should prepare in the insulin syringe?
  1. a.
    15 units
  2. b.
    23 units
  3. c.
    38 units
  4. d.
    12 units

Answer

C. 38 units
The nurse should combine the regular insulin and the NPH in the same syringe so a total of 38 units should be prepared, with regular insulin being drawn up first.

28-8 §28.RQ source ↗

Which of the following insulins can be administered via an insulin pump?
  1. a.
    Insulin glargine
  2. b.
    Insulin isophane NPH
  3. c.
    Insulin aspart
  4. d.
    Insulin detemir

Answer

C. Insulin aspart
Only rapid-acting insulins should be administered via an insulin pump. Insulin aspart is a rapid-acting insulin.

28-9 §28.RQ source ↗

A 76-year-old client with diabetes and renal impairment is scheduled for a diagnostic test requiring the use of contrast dye. Which of the following drugs should the nurse instruct the client to stop taking 24 hours prior to the procedure?
  1. a.
    Metformin
  2. b.
    Insulin lispro
  3. c.
    Glipizide
  4. d.
    Linagliptin

Answer

A. Metformin
Metformin should be held 24 hours prior to and 48 hours after contrast dye administration in clients with renal impairment.

28-10 §28.RQ source ↗

A nurse received a health care provider’s order to administer 750 mg of metformin twice daily to a client. Metformin is available in 500 mg tablets. How many tablets will the nurse administer per dose?
  1. a.
    1.5 tablets
  2. b.
    2 tablets
  3. c.
    3 tablets
  4. d.
    4 tablets

Answer

A. 1.5 tablets
750 m g x t a b l e t s (desired dose) = 500 m g 1 t a b l e t (supply on hand)
500 x = 750 × 1 x = 750 500 x = 1.5 t a b l e t s p e r d o s e .

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Problems and answers are adapted from Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris and Dorie Weaver, OpenStax, and are used under the CC BY-NC-SA 4.0 licence. Access for free at https://openstax.org/books/pharmacology/pages/1-introduction. Illustrations: Copyright Rice University, OpenStax, under CC BY-NC-SA 4.0 license. This adaptation is released under the same licence, is non-commercial, and is neither affiliated with nor endorsed by OpenStax or Rice University.