NUR 323 Final Exam Questions and
Complete Solutions
How might a person present or feel if experiencing hypoglycemia or hyperglycemia?
✅-Hypoglycemia → Clammy skin, sweating, nervousness, weakness, tiredness,
dizziness, confusion, blurred vision; Late symptoms include confusion, slurred speech,
and lightheadedness,
-To confirm hypoglycemia measure blood glucose level
-To avoid hypoglycemia the patient should avoid excess insulin, exercise, and alcohol
consumption on an empty stomach and eat about the same amounts and types of food
at the same time periods daily
-Diagnosed with a blood suagr less than 70 mg/dL
-Hyperglycemia → The three P's: Polyuria (increased urination), polydipsia (increased
thirst, polyphagia (increased appetite)
-Other symptoms include dehydration, headache, nausea, fatigue, weakness, weight
loss, vision changes numbness or tingling, fruity breath
What lab test are used to determine the extent of hyper/hypoglycemia? ✅-Blood →
Hemoglobin A1C (6.5% or higher), fasting blood glucose (>126) , causal blood glucose
(>200) , glucose tolerance test, fasting lipid profile, serum creatinine
-No imaging
-Urinalysis → Urine albumin (microalbuminuria), and ketones
-Electrocardiogram
What are the actions (including nursing and collaborative) would the nurse take in each
situation? ✅-Implementing care includes the need for referrals if needed
-Determine a health history of subjective and objective data
-Promote education for preventing and controlling diabetes
How are A1C and POC testing used in self-management of diabetes? ✅-A1C is the
best indicator of the average blood glucose level for the past 120 days
-Target goal is to be less than 7% in a person with diabetes
-POC is a bedside glucose test
What self-management strategies does the nurse support/teach for a patient with
diabetes ✅-Self-monitoring
-Continuous glucose monitoring
-Urine ketone monitoring
Why is self-glucose monitoring important? ✅-Self blood glucose is vital to diabetes
management
-Self-monitoring is a useful tool for those able to monitor blood glucose levels; Usually
2-4x daily (typical prior to meals and at bedtime)
,-Continuous glucose monitoring (infusion set, usually for type 1 diabetes)
-Urine ketone monitoring- indicates deficiency of insulin
Know differences in classifications of medication used in type 1 vs. type 2 diabetes
(insulins, oral antidiabetic agents). ✅-Oral antidiabetic agents and antidiabetic agents
(non-insulin injectables) for type 2 diabetes
-Insulin therapy for type 1 diabetes or type 2 diabetes
Types of oral antidiabetic agents ✅-Sulfonylureas: glipizide (Glucotrol)=
Increases insulin via by stimulating the beta cells
-Biguanides: metformin (Glucophage)=
First line treatment, Decrease glucose in the liver, Increases sensitivity to insulin
-Alpha-glucosidase inhibitors: acarbose (Precose)=
Delays absorption of complex carbohydrates, slows entry of glucose into circulation
-Non-Sulfonylurea insulin Secretagogues: repaglinide (Prandin)=
Stimulates pancreas to secrete insulin
-Thiazolidinediones: pioglitazone (Actos)=
Sensitize body tissue to insulin, simulate insulin receptor sites to increase BG and
improve action of insulin
-Dipeptidyl Peptidase-4 (DPP-4) inhibitors: Sitagliptin (Januvia)=
Prolong action of incretin (hormone that regulates insulin release and glucagon levels
Antidiabetic agents non-insulin injectables (subcutaneous) ✅-Incretin Mimetic:
exenatide (byetta)(subcutaneous)=
Slows digestions and increases insulin production
-Synthetic human amylin analogs: pramlintide (symlin)=
Inhibits postprandial glucagon secretion,
slows gastric emptying,
and mimics amylin
RAPID ACTING ✅-Lispro (humalog) → onset for 10 15 mins, peak at 1 hour, and
duration is about 2-4 hours
-Aspart (novolog) → Onset for 5-15 minutes, and peak at 50-50 minutes
-Glulisine (apidura) → Onset for 5-15 minutes, peak at 30-60 minutes, and duration of 2
hours
SHORT ACTING ✅-Regular (only insulin approved for IV use) → Onset for 1 to 1.5
hours, peak at 2-3 hours, and duration is 4-6 hours
-Humalog R → Onset for 1 to 1.5 hours, peak at 2-3 hours, and duration is 4-6 hours
-Novolin R → Onset for 1 to 1.5 hours, peak at 2-3 hours, and duration is 4-6 hours
-Iletin II regular → Onset for 1 to 1.5 hours, peak at 2-3 hours, and duration is 4-6 hours
INTERMEDIATE ACTING ✅-NPH (neutral protamine hagedorn) → onset for 2-4
hours, peaks at 4-12 hours, and duration of 16-20 hours
-Humulin N → onset for 2-4 hours, peaks at 4-12 hours, and duration of 16-20 hours
-Iletin II NPH → onset for 2-4 hours, peaks at 4-12 hours, and duration of 16-20 hours
, -Novolin N (NPH) → onset for 2-4 hours, peaks at 4-12 hours, and duration of 16-20
hours
PRE-MIXED ✅-Novolog mix 70/30 → onset for 15-30 minutes, peak at 1-4 hours, and
duration of 16-20 hours
-Humalog mix 75/35 → onset for 2-4 hours, peaks at 4-12 hours, and duration of 16-20
hours
-NPH/Regular 50/50 → onset for 2-4 hours, peaks at 4-12 hours, and duration of 16-20
hours
LONG ACTING ✅-Lantus (glargine) → onset for 1 hour, no peak because it is
continuous, and duration for 24 hours
-Levemir (detemir) → onset for 1 hour, no peak because it is continuous, and duration
for 24 hours
How do type 1 diabetic adjust insulin therapy for meals, exercise, illness? ✅-For those
with type 1 diabetes it is important there is sufficient glucose for cellular metabolism but
at the same time there is sufficient insulin available to guide glucose into cells
-A blood glucose level needs to be below 250 mg/dL and zero ketones before
exercising to prevent hyperglycemia, if there are ketones present then there is
insufficient available for the blood glucose levels
-Do not exercise within 1 hour of insulin injection or within peak time of insulin action
-Consider a complex carbohydrate snack prior to prevent unexpected blood glucose
drops
What medications are used and when if hypoglycemia occurs in a person with
diabetes? ✅-If conscious blood glucose <70 mg/dL...
15g-20g of a fast-acting concentrated source of carbohydrate,
2-3 glucose tablets, 1 tube glucose gel, 0.5 cup juice, 6 to 10 hard candies, or 1 tbsp of
honey (recheck glucose 15 minutes later)
-Follow up with snack including starch and protein such as cheese and crackers, milk
and cracker, or half a sandwich
-If unconscious or can't swallow and blood glucose <70 mg/dL...
1 mg glucagon injection (IM),
IV bolus of 25-50 ml of 50% dextrose (D50W)
-A 10g of glucose will increase the blood glucose by 40 mg/dL over 30 minutes
-A blood glucose of 50 mg/dL or less for a sustained period of time causes the brain to
suffer damage
What is a key difference for insulin administration in a person with type 1 or type 2
diabetes? ✅-Type 1 diabetics are insulin dependant; they don't produce insulin so it
must be regularly injected
