Diabetic Medications

ESSAY

1. a. What are the three main classifications of insulin activity (onset and/or duration)?

b. Does insulin elevate or lower blood glucose levels?

ANS:

a. Short/rapid; intermediate; long-acting

b. Lowers blood glucose

2. Ordered: NovoLog insulin 8 units subcut ac tid

a. Mark the dose on the syringe.

b. Is this a rapid-, intermediate-, or long-acting insulin?

c. What does U 100 mean?

ANS:

b. Rapid

c. 100 units per mL

3. Ordered: insulin glargine 28 units subcut at bedtime daily

a. What is the concentration in units per milliliter?

b. Mark the dose on the syringe.

c. Is this a rapid-, intermediate-, or long-acting insulin?

d. What is the major difference between insulin glargine and other insulins?

ANS:

a. 100 units per mL

c. Long-acting

d. Insulin glargine does not have a peak. It can be given any time of day as long as it is the same time each day.

4. Ordered: NovoLog 6 units subcut tid ac daily

a. Mark the dose on the syringe.

b. Is this a rapid-, intermediate-, or long-acting insulin?

c. Which types of patients particularly benefit from use of this type of syringe?

ANS:

b. Rapid

c. Patients with impaired vision benefit from using this syringe. Doses can be read more easily.

5. Ordered: an insulin mix—Humulin R 4 units, subcut AM and PM; Humulin N 26 units, 30 minutes before meals

a. Is Humulin N a rapid-, intermediate-, or long-acting insulin?

b. Which type of insulin should the nurse withdraw first for the mix: Humulin R or Humulin N? State the reason for this decision.

c. Mark the total dose. Indicate the Humulin R and Humulin N doses with arrows.

ANS:

a. Intermediate

b. The short/rapid acting Humulin R must be withdrawn first to protect it from contamination with a longer acting insulin. Contamination could change the action of the regular insulin.

c. First arrow shows 4 units drawn to Humulin R, total dose shown with second arrow at 30 units when Humulin N dose is added.

6. Ordered: Novolin R subcut per sliding scale q6h, for a patient receiving total parenteral nutrition

Blood Glucose (mg per dL)
Insulin (units)

70-150
0

151-200
4

201-250
6

251-300
10

a. The patient’s blood glucose level is 240 mg per dL. How many units should the nurse administer?

b. Why must U be written out as units in medical records?

ANS:

a. 6 units

b. U can be misread as 0 (zero)

7. Ordered: Humulin R 6 U per hr IV infusion

Recheck the blood glucose level in 1 hour and notify the prescriber’s office.

Available: 100 units Humulin R in 100 mL NS

How many milliliters per hour will the nurse set on the infusion pump?

a. Estimated flow rate:

b. DA equation:

c. Evaluation:

d. Why should diet beverages not be given if hypoglycemic reaction is suspected or occurring?

ANS:

a. Estimate: 6 mL per hour

c. Equation is balanced. Only mL per hour remains. Note: If the concentration is 1:1, such as 100 mL, mL per hour will equal the ordered units per hour.

d. Dextrose is needed to elevate blood glucose levels. Diet beverages contain dextrose substitutes, which do not affect blood glucose promptly or adequately.

8. Ordered: Humulin Regular insulin infusion IV at 4 units per hr

Available: 50 units

Humulin Regular insulin in100 mL of NS

How many milliliters per hour should the nurse set on the infusion pump?

a. Estimated flow rate:

b. DA equation:

c. Evaluation:

d. What are the only insulin products that may be administered intravenously?

ANS:

a. Estimate: The concentration is or 2 mL for each unit; therefore, the flow rate estimate is 8 mL per hour.

c. Equation is balanced. Estimate supports answer. Only mL per hour remain.

d. Regular insulin products and insulin lispro (Humalog) may be administered intravenously. Intermediate, long-acting, mixed insulins, and insulin aspart (NovaLog) cannot be administered intravenously due to additives.

9. Ordered: insulin infusion, Humulin R 7 units per hr

Infusing: insulin Humulin R infusion at 10 mL per hr

Available: 100 units Humulin R in 100 mL NS

How many units of insulin are infusing?

a. Estimate:

b. DA equation:

c. Evaluation:

How many milliliters per hour will deliver the ordered flow rate?

d. Estimate:

e. DA equation:

f. Evaluation:

g. Decision:

ANS:

a. 10 units (the concentration is 1 unit: 1 mL)

c. Equation is balanced. Estimate supports answer. Only units per hour remain.

d. Estimate: 7 mL per hour.

f. Equation is balanced. Estimate supports answer.

g. Flow rate is excessive and needs to be reduced to 7 mL per hour. Notify the prescriber promptly. Monitor the patient and blood glucose levels for hypoglycemia.

10. a. What two products must be on hand for IV administration for a severe hypoglycemic reaction?

b. What kinds of insulins require a bedtime snack unless otherwise ordered?

c. State the reason.

ANS:

a. 50% Dextrose and Glucagon

b. Evening insulins and long-acting insulins

c. To help prevent a hypoglycemic reaction during sleep

11. Name the two types of diabetes mellitus.

ANS:

DM type 1 and DM type 2

12. If a patient is to receive a premixed insulin as noted on the label below, which number indicates the intermediate-acting insulin percentage?

ANS:

The first number refers to the intermediate acting insulin.

13. If a patient’s blood glucose level is 295, which insulin infusion rate would you administer according the sliding scale below?

Blood Glucose Level (mg per dL)
Infusion Rate (units per hr)
151-200
1
201-250
2
251-300
3
301-400
4
Over 400
5 and call MD

ANS:

3 units per hr

14. What is a normal fasting blood glucose range in mg per dL?

ANS:

70 to 100 mg per dL. The preferred norm varies among physicians. A result in the low 80 mg per dL is preferred by some physicians. Fasting means only water for 8 hours before the test. Caffeine and other products will raise the fasting blood sugar.

15. What is the major side effect of insulin overdose?

ANS:

hypoglycemia

16. Name the route that is most commonly prescribed for patients to self-administer insulin.

ANS:

subcut

17. What is the name of the hormone that may be administered by injection for severe hypoglycemic levels?

ANS:

glucagon

18. What is the difference between BGM and SMBG testing?

ANS:

SMBG refers to fingerstick self-monitoring, reported by patient. BGM refers to fingerstick report, usually done by nurse.

19. If a patient receives insulin and doesn’t eat, what happens to the blood glucose level?

ANS:

Blood glucose level drops; hypoglycemia occurs.

20. If the patient doesn’t take the prescribed antidiabetic medicine, what happens to the blood glucose level?

ANS:

Blood glucose level rises; hyperglycemia occurs.

21. What is the most commonly ordered insulin concentration per mL?

ANS:

100 U per mL

22. When giving insulin injections subcutaneously, what area on the abdomen must be avoided and by how many inches of radius?

ANS:

Umbilicus should be avoided by radius of 2 inches.

23. A sliding scale insulin order is based on what kind of test?

ANS:

A current blood glucose level

24. What serious ADE could the nurse expect if the dose prepared for an order of 4 units of Regular insulin and 26 units of intermediate acting insulin was reversed?

ANS:

The patient would rapidly become hypoglycemic and have high probability of insulin shock.

25. Which specific part of the following sliding scale would necessitate clarification with the prescriber?

Blood Glucose Level (mg per dL)
Regular Insulin (units subcut)
0-180
0 units
180-250
2 units
251-300
4 units
300-350
6 units
Over 350
8 units and call MD

ANS:

The 180 level is indicated for two of the orders: 0 and 2 units.

26. Can long-acting insulins be given IV? If so, why; if not, why not?

ANS:

Long-acting insulins cannot be given IV. They contain additives to extend the action.

27. Why are bedtime snacks such as half of a sandwich or milk ordered for patients on intermediate and long-acting or evening insulin?

ANS:

Intermediate, evening, and long-acting insulins lower blood sugar during the night. To avoid hypoglycemic episodes during sleep, or during the night, a balanced small snack is given.

MULTIPLE CHOICE

1. A test that determines the average blood glucose level over the past 2 to 3 months is called:

a.
HbA1c (glycosolated hemoglobin)
b.
Fasting blood glucose (FBS)
c.
Postprandial glucose test
d.
BGM

ANS: A

2. What does U 100 on an insulin label mean exactly?

a.
100 units of total contents in the bottle
b.
100 units per mL
c.
100 units is the usual dose
d.
100 units per hr is recommended

ANS: B

3. If a patient is having a hypoglycemic episode, which of the following choices would be best to give first if the patient is able to swallow?

a.
Diet cola
b.
Coffee (caffeine)
c.
Orange juice
d.
An antidiabetic pill

ANS: C