NUR 243 Exam 3 Review Questions and Complete Solutions
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Course
NUR 243
Institution
NUR 243
A patient who has type 2 diabetes has a glycated hemoglobin A1c (HbA1c) of 10%. The nurse should make which change to the nursing care plan? Refer the patient to a diabetes educator because the result reflects poor glycemic control. Glycemic control is adequate; no changes are needed. Hypoglycemia ...
NUR 243 Exam 3 Review Questions and
Complete Solutions
A patient who has type 2 diabetes has a glycated hemoglobin A1c (HbA1c) of 10%. The
nurse should make which change to the nursing care plan?
Refer the patient to a diabetes educator because the result reflects poor glycemic
control.
Glycemic control is adequate; no changes are needed.
Hypoglycemia is a risk; teach the patient the symptoms.
Instruct the patient to limit activity and weekly exercise. ✅Refer the patient to a
diabetes educator because the result reflects poor glycemic control.
A patient who has type 2 diabetes is taking nateglinide [Starlix]. Which response should
a nurse expect the patient to have if the medication is achieving the desired therapeutic
effect?
Inhibition of carbohydrate digestion
Promotion of insulin secretion
Decreased insulin resistance
Inhibition of ketone formation ✅Promotion of insulin secretion
Nateglinide is a meglitinide medication that acts to increase pancreatic insulin release. It
is used as an adjunct to calorie restriction and exercise to maintain glycemic control in
patients with type 2 diabetes. It does not act to reduce insulin resistance or inhibit
carbohydrate digestion. It should not be used to manage diabetic ketone formation,
because its glucose-lowering effects are too slow to be of benefit.
Which instruction should the nurse provide when teaching a patient to mix regular
insulin and NPH insulin in the same syringe?
"Draw up the clear regular insulin first, followed by the cloudy NPH insulin."
"It is not necessary to rotate the NPH insulin vial when it is mixed with regular insulin."
"The order of drawing up insulin does not matter as long as the insulin is refrigerated."
"Rotate subcutaneous injection sites each day among the arm, thigh, and abdomen."
✅"Draw up the clear regular insulin first, followed by the cloudy NPH insulin."
To ensure a consistent response, only NPH insulin is appropriate for mixing with a
short-acting insulin. Unopened vials of insulin should be refrigerated; current vials can
be kept at room temperature for up to 1 month. Drawing up the regular insulin into the
syringe first prevents accidental mixture of NPH insulin into the vial of regular insulin,
which could alter the pharmacokinetics of subsequent doses taken out of the regular
insulin vial. NPH insulin is a cloudy solution, and it should always be rotated gently to
disperse the particles evenly before loading the syringe. Subcutaneous injections
,should be made using one region of the body (eg, the abdomen or thigh) and rotated
within that region for 1 month.
A patient is scheduled to start taking insulin glargine [Lantus]. On the care plan, a nurse
should include which of these outcomes related to the therapeutic effects of the
medication?
Blood glucose control for 24 hours
Mealtime coverage of blood glucose
Less frequent blood glucose monitoring
Peak effect achieved in 2 to 4 hours ✅Blood glucose control for 24 hours
Insulin glargine is administered as a once-daily subcutaneous injection for patients with
type 1 diabetes. It is used for basal insulin coverage, not mealtime coverage. It has a
prolonged duration, up to 24 hours, with no peaks. Blood glucose monitoring is still an
essential component to achieve tight glycemic control.
A patient who took NPH insulin at 0800 reports feeling weak and tremulous at 1700.
Which action should the nurse take?
Take the patient's blood pressure.
Give the patient's PRN dose of insulin.
Check the patient's capillary blood sugar.
Advise the patient to lie down with the legs elevated. ✅Check the patient's capillary
blood sugar.
The patient is showing symptoms of hypoglycemia at 5:00 PM. NPH has a peak action
of 8 to 10 hours after administration. Based on the duration of action of NPH insulin, the
patient's hypoglycemic symptoms are from the 8:00 AM injection of NPH insulin. An
injection of NPH insulin at 2:00 AM, 1:00 PM, or 3:00 PM would not cause hypoglycemic
symptoms based on the average duration of action of NPH insulin.
A teaching plan for a patient who is taking lispro [Humalog] should include which
instruction by the nurse?
"Inject this insulin with your first bite of food, because it is very fast acting."
"The duration of action for this insulin is about 8 to 10 hours, so you'll need a snack."
"This insulin needs to be mixed with regular insulin to enhance the effects."
"To achieve tight glycemic control, this is the only type of insulin you'll need." ✅"Inject
this insulin with your first bite of food, because it is very fast acting."
Lispro is a rapid-acting insulin and has an onset of action of 15 to 30 minutes with a
peak action of about 2 hours, not 8 to 10 hours. Because of its rapid onset, it is
administered immediately before a meal or with meals to control the blood glucose rise
after meals. Lispro insulin must be combined with an intermediate- or a long-acting
insulin, not regular insulin (which also is a short-duration insulin), for glucose control
, between meals and at night. To achieve tight glycemic control, patients must combine
different types of insulin based on their duration of action
A patient newly diagnosed with type 1 diabetes asks a nurse, "How does insulin
normally work in my body?" The nurse explains that normal insulin has which action in
the body?
It stimulates the pancreas to reabsorb glucose.
It promotes the synthesis of amino acids into glucose.
It stimulates the liver to convert glycogen to glucose.
It promotes the passage of glucose into cells for energy. ✅It promotes the passage of
glucose into cells for energy.
The hormone insulin promotes the passage of glucose into cells, where it is metabolized
for energy. Insulin does not stimulate the pancreas to reabsorb glucose or synthesize
amino acids into glucose. It does not stimulate the liver to convert glycogen into
glucose.
A patient is taking glipizide [Glucotrol] and a beta-adrenergic medication. A nurse is
teaching hypoglycemia awareness and should warn the patient about the presence of
which symptom?
Vomiting
Muscle cramps
Tachycardia
Chills ✅Tachycardia
Glipizide is a sulfonylurea oral hypoglycemic medication that acts to promote insulin
release from the pancreas. Beta-adrenergic blockers can mask early signs of
sympathetic system responses to hypoglycemia; the most important of these is
tachycardia, which is the most common adverse effect of glipizide. Vomiting, muscle
cramps, and chills are not symptoms of activation of the sympathetic nervous system
that arise when glucose levels fall.
A nurse assesses a patient who is taking pramlintide [Symlin] with mealtime insulin.
Which finding requires immediate follow-up by the nurse?
Skin rash
Sweating
Itching
Pedal edema ✅Sweating
Pramlintide is a new type of antidiabetic medication used as a supplement to mealtime
insulin in patients with type 1 and 2 diabetes. Hypoglycemia, which is manifested by
sweating, tremors, and tachycardia, is the adverse reaction of most concern. Skin rash,
itching, and edema are not adverse effects of pramlintide.
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