Chapter 52: Antidiabetics Nursing School Test Banks

Chapter 52: Antidiabetics
Test Bank

MULTIPLE CHOICE

1. The nurse is teaching a group of nursing students about diabetes. The nurse explains that which type of diabetes is the most common?
a. Type 1 diabetes mellitus
b. Type 2 diabetes mellitus
c. Diabetes insipidus
d. Secondary diabetes
ANS: B
Type 2 diabetes mellitus is the most common type of diabetes.

DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: Page 759
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pathophysiology

2. A patient develops type 2 diabetes mellitus. The nurse will explain that this type of diabetes
a. is generally triggered by medications.
b. is not as common as type 1 diabetes.
c. is often related to heredity and obesity.
d. will not require insulin therapy.
ANS: C
Type 2 diabetes is often caused by obesity and hereditary factors. Secondary diabetes is triggered by medications. Type 2 diabetes is the most common type of diabetes. Patients with type 2 diabetes may become insulin-dependent.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 759
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pathophysiology

3. A patient who is overweight is being evaluated for diabetes. The patient has a blood glucose level of 160 mg/dL and a hemoglobin A1c of 5.8%. The nurse understands that this patient has which condition?
a. Diabetes mellitus
b. Hypoglycemia
c. Normal blood levels
d. Prediabetes
ANS: D
Patients with a hemoglobin A1c between 5.7% and 6.4% are considered to have prediabetes. A level of 6.5% or more indicates diabetes. The patient is hyperglycemic.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 759
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pathophysiology

4. The nurse is teaching a patient who is newly diagnosed with type 1 diabetes mellitus about insulin administration. Which statement by the patient indicates a need for further teaching?
a. I may use a chosen site daily for up to a week.
b. I should give each injection a knuckle length away from a previous injection.
c. I will not be concerned about a raised knot under my skin from injecting insulin.
d. Insulin is absorbed better from subcutaneous sites on my abdomen.
ANS: C
Lipohypertrophy is a raised lump or knot on the skin surface caused by repeated injections into the same site, and this can interfere with insulin absorption. Patients are encouraged to use the same site for a week, giving each injection a knuckle length away from the previous injection. Insulin absorption is greater when given in abdominal areas.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 760
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. The nurse is teaching a patient how to administer insulin. The patient is thin with very little body fat. The nurse will suggest injecting insulin
a. by pinching up the skin and injecting straight down.
b. in the abdomen only with the needle at a 90-degree angle.
c. subcutaneously with the needle at a 45- to 60-degree angle.
d. using the thigh and buttocks areas exclusively.
ANS: C
In a thin person, with little fatty tissue, the needle is inserted at a 45- to 60-degree angle. In other patients, a 45- to 90-degree angle is acceptable. There is no recommendation for preferring one site over another.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 760
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. The nurse receives the following order for insulin: IV NPH (Humulin NPH) 10 units. The nurse will perform which action?
a. Administer the dose as ordered.
b. Clarify the insulin type and route.
c. Give the drug subcutaneously.
d. Question the insulin dose.
ANS: B
Only regular insulin can be given intravenously. The nurse should clarify the order. It is not correct to give Humulin NPH insulin IV. The nurse should not administer the drug by a different route without first discussing with the provider.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 760
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. The nurse will administer parenteral insulin to a patient who will receive a mixture of NPH (Humulin NPH) and regular (Humulin R). The nurse will give this medication via which route?
a. Intradermal
b. Intramuscular
c. Intravenous
d. Subcutaneous
ANS: D
Insulin is given by the subcutaneous route. Only regular insulin may be given IV.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 760
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. The nurse is teaching a patient about home administration of insulin. The patient will receive regular (Humulin R) and NPH (Humulin NPH) insulin at 0700 every day. What is important to teach this patient?
a. Draw up the medications in separate syringes.
b. Draw up the NPH insulin first.
c. Draw up the regular insulin first.
d. Draw up the medications after mixing them in a vial.
ANS: C
Patients should be instructed to draw up regular insulin first so that NPH is not mixed into the vial of regular insulin. It is not necessary to use separate syringes. Patients do not mix the medications in a vial.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 760
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. A patient is ordered to receive insulin lispro at mealtimes. The nurse will instruct this patient to administer the medication at which time?
a. 5 minutes before eating
b. 15 minutes after eating
c. 30 minutes before eating
d. 10 minutes after eating
ANS: A
Lispro acts faster than other insulins, and patients should be taught to give this medication not more than 5 minutes before eating.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 760
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

10. The parent of a junior high-school child who has type 1 diabetes asks the nurse if the child can participate in sports. The nurse will tell the parent
a. that strenuous exercise is not recommended for children with diabetes.
b. that the child must be monitored for hyperglycemia while exercising.
c. to administer an extra dose of regular insulin prior to exercise.
d. to send a snack with the child to eat just prior to exercise.
ANS: D
Patients generally need less insulin with increased exercise, so the child should consume a snack to prevent hypoglycemia. Exercise is an integral part of diabetes management. Hypoglycemia is more likely to occur, and extra insulin is not indicated.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 765
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. A patient has administered regular insulin 30 minutes prior but has not received a breakfast tray. The patient is experiencing nervousness and tremors. What is the nurses first action?
a. Administer glucagon.
b. Give the patient orange juice.
c. Notify the kitchen to deliver the tray.
d. Perform bedside glucose testing.
ANS: B
The patient is symptomatic and has hypoglycemia. The nurse should give orange juice. Glucagon is given for patients unable to ingest carbohydrates. The kitchen should be notified, and bedside glucose testing should be performed, but only after the patient is given carbohydrates.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 765
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

12. A patient who has type 1 diabetes mellitus asks the nurse about using a combination insulin product such as Humalog 75/25. The nurse will tell the patient that use of this product
a. depends on individual insulin needs.
b. is useful for patient with insulin resistance.
c. means less rotation of injection sites.
d. requires refrigeration at all times.
ANS: A
Combination products are convenient because the patient does not have to mix insulin, but the products depend on individual needs, since the doses are fixed. They are not used for patients with insulin resistance. Patients must continue to rotate injection sites. They do not require refrigeration after first use.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 760
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

13. The patient asks the nurse about storing insulin. Which response by the nurse is correct?
a. All insulin vials must be refrigerated.
b. Insulin will last longer if kept in the freezer.
c. Opened vials of insulin must be discarded.
d. Some combination pens do not require refrigeration.
ANS: D
Some combination pens do not require refrigeration after first use. Storing insulin in the freezer is not recommended. Opened vials may either be kept at room temperature for a month or refrigerated for 3 months.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 761
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

14. A patient who has insulin-dependent diabetes mellitus must take a glucocorticoid medication for osteoarthritis. When teaching this patient, the nurse will explain that there may be a need to
a. decrease the glucocorticoid dose.
b. decrease the insulin dose.
c. increase the glucocorticoid dose.
d. increase the insulin dose.
ANS: D
Glucocorticoids can cause hyperglycemia, so the insulin dose may need to be increased. Changing the glucocorticoid dose is not recommended. Decreasing the insulin dose will only compound the hyperglycemic effects.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 761
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

15. Which statement by a patient who will begin using an external insulin pump indicates understanding of this device?
a. I will have an increased risk for hypoglycemia.
b. I will leave this on when bathing or swimming.
c. I will not need to count carbohydrates anymore.
d. I will still need to monitor serum glucose.
ANS: D
Patients using an insulin pump will still monitor serum glucose and count carbohydrates. The advantage of the pump is that it is programmed to deliver continuous rapid-acting insulin in varying amounts at different times throughout the day. Changes in food intake can alter the risk for hypoglycemia if the pump is not adjusted accordingly. They must be removed when bathing or swimming.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 764
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

16. A patient who is unconscious and has a pulse is brought to the emergency department. The patient is wearing a Medic-Alert bracelet indicating type 1 diabetes mellitus. The nurse will anticipate an order to administer
a. cardiopulmonary resuscitation (CPR).
b. glucagon.
c. insulin.
d. orange juice.
ANS: B
This patient is most likely hypoglycemic and will need a carbohydrate. Glucagon is given parenterally if patients are unable to ingest a carbohydrate, such as orange juice. CPR is not indicated. Insulin will compound the hypoglycemia.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 765
TOP: NURSING PROCESS: Planning/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

17. A patient who has type 2 diabetes mellitus asks the nurse why the provider has changed the oral antidiabetic agent from tolbutamide (Orinase) to glipizide (Glucotrol). The nurse will explain that glipizide
a. has a longer duration of action.
b. has fewer gastrointestinal side effects.
c. may be taken on an as-needed basis.
d. results in less hypoglycemic potential.
ANS: A
Glipizide is a second-generation oral antidiabetic agent. It has a longer duration of action than the first-generation antidiabetic agents such as tolbutamide. It has many gastrointestinal side effects. It is taken once daily, not as needed. It has greater hypoglycemic activity than first-generation antidiabetics.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 768
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

18. A patient who has been taking a sulfonylurea antidiabetic medication will begin taking metformin (Glucophage). The nurse understands that this patient is at increased risk for which condition?
a. Hypoglycemia
b. Hyperglycemia
c. Renal failure
d. Respiratory distress
ANS: C
Metformin can lead to renal failure. It does not produce hypoglycemia or hyperglycemia. It does not increase the risk of respiratory distress.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 769
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

19. A 45-year-old patient who is overweight has had a diagnosis of type 2 diabetes for 2 years. The patient uses 20 units of insulin per day. The patients fasting blood glucose (FBG) is 190 mg/dL. The patient asks the nurse about using an oral antidiabetic agent. The nurse understands that oral antidiabetic agents
a. cannot be used if the patient is overweight.
b. cannot be used once a patient requires insulin.
c. may be used since this patient meets criteria.
d. may not be used since this patients fasting blood glucose is too high.
ANS: C
Patients who require less than 40 units of insulin per day and who have a fasting blood glucose less than or equal to 200 mg/dL are candidates for oral antidiabetic agents. Being overweight is an indication, not a contraindication.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 770
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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