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EDAPT: Glucose Regulation Exam
1. Which health alteration is characterized by the lack of insulin production?: Di- abetes mellitus
type 1
2. Where is insulin produced in the human body?: Pancreas
3. When taking insulin, the intent is to lower which laboratory value to achieve findings
within the normal range?: Glucose
4. For each client listed, indicate if the client must use insulin, may need insulin, or does
not need insulin.: Must Use Insulin:
• A teenaged client whose pancreas does not produce insulin.
May Need Insulin:
• A woman in the third trimester of pregnancy with an elevated blood glucose level.
• An adult with diabetes mellitus type 2 taking an oral antidiabetic medication who is ill.
Does Not Need Insulin:
• A client who is obese and has a blood sugar higher than normal, but less than 126 mg/mL.
5. Which insulin formulations are currently available in the U.S.? Select all that apply.:
Short-acting Intermediate-acting Rapid-acting
2 / 30 Long-acting
6. The nurse administering insulin to a client with diabetes mellitus type 1 is responsible
for knowing what key information about the drug? Select all that apply.: Strength Peak Onset Duration
7. The nurse preparing a client's 0730 dose of lispro insulin should confirm that a meal tray
will be available and the client ready to eat at what time?: 0730
8. What symptoms provided by the client indicate to the nurse that a client with a new
prescription for intermediate-acting insulin understands insulin-related hypoglycemic reactions? Select all that apply.: Palpitations Weakness Shakes Diaphoresis
9. The nurse educates the client on the importance of having adequate glucose available
during which time/action components of insulin administration? Se- lect all that apply.: Peak Onset
10. Which client is at greatest risk of experiencing frequent hypoglycemia?: A client with
diabetes mellitus type 1
11. Use the drop-down menus on the graph to indicate the type of insulin
pharmacokinetics represented.: 1. Rapid-acting
2. Short-acting
3. Intermediate-acting
4. Long-acting
4 / 30
20. Lispro insulin lowers blood glucose by regulating the metabolism of which
nutrients? Select all that apply.: Fats Proteins Carbohydrates
21. What is the route of administration of lispro?: Subcutaneous
22. After subcutaneous injection, how quickly does lispro's therapeutic effect begin?:
15 minutes
23. Thirty (30) minutes after administering lispro to a client with diabetes melli- tus
type 1, the nurse returns to the room and sees the client has not eaten their lunch. When asked how they feel, which client responses indicate to the nurse that the client is experiencing hypoglycemia related to the lispro injection? Select all that apply.: Palpitations Tremors Weakness Tachycardia
24. While preparing to administer a prescribed dose of lispro to a client, the nurse
discovers that the unit is out of lispro insulin. Which action should the nurse take next? : Notify the pharmacy of the missing medication.
25. The nurse evaluates a client's understanding of hypoglycemia caused by insulin
administration. Which clinical manifestations listed by the client indicate they will be able to recognize an insulin-related hypoglycemic episode? Select all that apply.: Diaphoresis Tachycardia
26. The nurse administers lispro to the client at 0800. The nurse should remind the
client to eat right away since the onset of action for this dose of lispro will begin at what time?: 0815
27. The nurse administered lispro insulin to a client at 0730 after verifying the
5 / 30 client intended to eat their breakfast, which was present in the room. The client asks how long the effects of the lispro will last. What is the best response by the nurse?: "Lispro's ettects last between 3-5 hours."
28. In which situation is it appropriate to administer the first dose of lispro insulin to
a client newly diagnosed with diabetes mellitus type 1?: The meal tray is present at the time of administration.
29. The nurse determines that the client understands treating hypoglycemia when
they identify which items as containing 15 grams of simple carbohy- drates? Select all that apply.: A serving of glucose gel Five to six pieces of hard candy One tablespoon of sugar
30. A client who received lispro at 0810 is discovered by the nurse at 0915 in bed. The
client is pale, diaphoretic, and mumbles when asked how they are feeling. Which nursing intervention is the highest priority for this client?: Measure capillary blood glucose level at the bedside.
31. After administering a dose of lispro at 0915, the nurse should plan to return to the
client's room to reassess their response to the peak effect of the insulin at what time?: 1015
32. For each clinical manifestation listed, specify if it is likely to be present or not
likely to be present in a client who received 15 units of rapid-acting insulin and was taken for an x-ray before finishing their meal.: Likely to Occur: Palpitations Weakness Lethargy Not Likely to Occur: Drowsiness Polyuria
7 / 30
37. For each action listed, specify if the nurse should or should not complete the
action prior to administering a prescribed subcutaneous (subq) dose of short-acting insulin.: Nurse Should Complete:
- Assess the blood glucose level.
- Confirm the type of insulin with another licensed nurse. Nurse Should Not Complete:
- Administer 1 hour prior to a meal.
- Remind the client to remain in bed for 30 minutes.
- Use the same injection site for one week.
38. When administering regular insulin intravenously (IV), the nurse expects the onset
of action to begin within what time frame?: 10 minutes
39. The nurse is identifying a client before administering a dose of regular insulin
and notices the client is scratching their abdomen to the right side of their naval. When asked if the area is painful or irritating, the client replied, "It itches a bit, and I noticed it yesterday about 30 minutes after my evening
8 / 30 insulin shot." Which assessment cues, if present, should the nurse recognize as being related to a localized reaction to the shot? Select all that apply.: Pruritis Inflammation Erythema
40. When caring for an unstable client in the intensive care unit (ICU) with a
dangerously high serum blood glucose, the nurse should prepare to administer regular insulin via which route?: Intravenous (IV)
41. The nurse is caring for a client who is alert, oriented, and cooperative, de- spite
having diabetic ketoacidosis (DKA). As the nurse is starting the prescribed insulin via continuous intravenous infusion, which symptoms should the nurse instruct the client to report immediately? Select all that apply.: Diaphoresis Fast heart rate
42. While completing a medication reconciliation for a client admitted to the
hospital, the nurse notes that the client's regular insulin and insulin isophane suspension (NPH) both have a cloudy appearance. What information should the nurse give to the client?: "When you get home, get a new bottle of regular insulin."
43. Twenty minutes after the nurse administered 15 units of regular insulin
subcutaneously to a client at 0815, the healthcare provider scheduled a proce- dure at 1230 for which the client must be NPO (having no oral intake) starting immediately. The nurse should recognize that the client is at high risk for in the next minutes and again close to the of the procedure.: Hy- poglycemia
10 / 30 Glucose Mellitus
51. With type 1 or type 2 diabetes mellitus, NPH insulin controls which of the
following?: Hyperglycemia
52. The first five nights after Amelia (pronouns she, her, hers) started adminis- tering
the combined neutral protamine hagedorn (NPH) and regular insulin, she woke during the night with symptoms of low blood sugar. What is the most likely instruction her parent received from the pediatric endocrinologist?: Eat a snack before bedtime.
53. What is the route of administration for intermediate-acting insulin?: Subcuta-
neous
54. What other types of insulin can intermediate-acting insulin be mixed with in a
syringe for administration as a single injection? Select all that apply.: Rapid-acting insulin Short-acting insulin
55. What is the onset of intermediate-acting insulin?: 1-2 hours
56. The nurse is caring for a client who received intermediate-acting insulin at 0730. It
is now 1300, and the client tells the nurse they feel weak, have the shakes, and their heart is racing. The nurse notes the client is diaphoretic, as well. After seeing the client's lunch tray sitting at the bedside with most of the food untouched, the nurse should understand that the clinical manifestations are most likely a result of which factors? Select all that apply.: The peak ettect of the intermediate-acting insulin. Skipping a meal since the intermediate-acting insulin was administered.
57. After administering intermediate-acting insulin to a client at 0800, the nurse
should understand that the onset of action will occur at what time?: Between 0900 and 1000
11 / 30
58. After administering intermediate-acting insulin to a client at 0800, the nurse
should understand that the duration of action will end at what time?: Between 1800 and 0200
59. After administering intermediate-acting insulin to a client at 0800, the nurse
should understand that the peak effect will occur at what time?: Between 1200 and 1600
60. The nurse should expect the appearance of insulin isophane suspension (aka NPH) to
have which characteristic?: Cloudy
61. Place the steps the nurse should take when combining different types of insulin
in one syringe in the correct order.: 1. Wash hands
2. Gently rotate insulin isophane suspension (NPH) vial
3. Wipe tops of both vials with alcohol.
4. Inject air equal to NPH dose into NPH vial.
5. Inject air equal to regular dose into regular vial.
6. Invert regular insulin bottle and withdraw regular insulin dose.
7. Without adding more air to the inverted NPH vial, carefully insert the syringe and withdraw the NPH dose.
62. After administering a single injection of insulin isophane suspension (NPH) to a
client at 0730, at what time should the nurse return to the client's room to make sure they
13 / 30 24 hours
69. What is true about mixing insulin glargine?: Not compatible with other insulins.
70. What is the onset for insulin glargine?: 1-2 hours
71. The nurse is caring for a client living with diabetes mellitus type 1 who receives
85 units of insulin glargine at 2100 daily. The client was admitted with prolonged vomiting due to gastroenteritis and has been unable to take in food or fluids for the last day. This client is at high risk of developing prolonged due to and .: Hypoglycemia Not eating Taking glargine
72. Which clients should benefit from the addition of glargine to their diabetes mellitus (DM)
treatment plan? Select all that apply.: An adolescent living with DM type 1 whose serum glucose fluctuates widely. An adult with DM type 2 who is not achieving glycemic control on oral medications. An adult whose serum glucose is well controlled on two daily injections of insulin isophane suspension (NPH).
73. After administering insulin glargine to a client at 2100, the nurse should
anticipate that the client's serum glucose level may start to decrease at what time?: The same day between 2200 and 2300.
74. After administering insulin glargine to a client at 2100, the nurse should anticipate
that the client's serum glucose level may drop due to the medication peaking at what time?: At no time
75. After administering insulin glargine to a client at 2100, the nurse should an- ticipate
14 / 30 that the client's serum glucose may increase around what time?: Around 2030 the next day.
76. When teaching a client about their newly prescribed long-acting insulin, the nurse
should encourage the client to eat within what time frame around their daily injection?: The next time they are hungry.
77. While preparing the pre-breakfast insulin dose for a client, the nurse should
question which aspect of the healthcare provider's prescription? Select one (1) option only. Insulin glargine 55 units with 10 units lispro subcutaneously as one injection daily before bed.: With 10 units lispro
78. A client being treated with oral antidiabetic medications asks the nurse to explain
how one shot of insulin glargine each day can improve their diabetes mellitus (DM) type 2. Which response by the nurse is best?: "Insulin glargine helps your muscle and fat cells use glucose."
79. A client taking which type of insulin to treat their diabetes mellitus (DM) is least
likely to experience hypoglycemia if they skip a meal?: Long-acting
80. A client whose diabetes mellitus is well-controlled with a single injection of
insulin glargine has been admitted to the intensive care unit (ICU) with diabetic ketoacidosis (DKA). In addition to receiving the normal dose of glargine subcutaneously, the client is also on a continuous intravenous (IV) infusion of regular insulin. The client asks the nurse why the glargine cannot be given through the IV as well. What is the best response by the nurse?: "Glargine forms small crystals in the body which could harm you if given IV."
81. What foundational knowledge about insulin should the nurse possess to ensure
the safe administration of insulin to clients? Select all that apply.: Peak ettect Duration of action Prescribed route Prescribed dose
16 / 30 to cup and then mouth Client rubbing head Capillary glucose Shivering
85. The nurse is caring for a young adult admitted to the intensive care unit (ICU) with
pneumonia and hyperglycemia. For each clinical manifestation below, specify if it could be caused by diabetes mellitus (DM) type 1, intubation, or pneumonia.: DM Type 1: Capillary glucose Dry mouth Shivering Headache Intubation: Dry mouth Pneumonia: Capillary glucose Shivering Headache
86. The nurse is caring for a young adult admitted to the intensive care unit (ICU) with
pneumonia and hyperglycemia. The nurse should first address the client's , followed by the client's .: Serum glucose Temperature
87. The nurse is caring for a young adult admitted to the intensive care unit (ICU) with
17 / 30 pneumonia and hyperglycemia. For each nursing action, specify if it is indicated, nonessential, or contraindicat- ed.: Indicated:
- Administer lispro insulin subcutaneously per sliding scale. Nonessential:
- Increase temperature in room.
- Notify the healthcare provider of serum glucose. Contraindicated:
- Administer acetaminophen 650 mg orally for fever.
- Increase IV fluids to dilute serum glucose.
- Wait at least 4 hours to recheck serum glucose.
88. The nurse is caring for a young adult admitted to the intensive care unit (ICU) with
pneumonia and hyperglycemia. Since it is 2045 and the client is due to receive the evening dose of NPH, the nurse decides to mix the sliding scale dose of lispro with the NPH. Place the steps the nurse should follow to safely mix the insulins in one syringe in the correct order.: 1. Wash hands
2. Gently rotate the intermediate-acting insulin vial.
19 / 30 all that apply. : Drops the needle into the appropriate container. Selects the anterior thigh. Rotates the injection site.
92. Which pharmacokinetic variables should the nurse teach the client about
insulin? Select all that apply.: Peak Duration Onset
93. A client becomes upset while learning how to administer their newly pre- scribed
insulin. What is the best response by the nurse when the client says, "I cannot do this for the rest of my life," and walks to the other side of the room?: "This is a big change. Would you like to talk about how this is attecting you?"
94. The nurse administers 14 units of insulin isophane suspension (NPH) to a client at
0700 in the lower right quadrant of the abdomen. Before leaving the room, the nurse should inform the client that someone should be back to recheck their glucose around what time?: 1130
95. The nurse receives a call from the unlicensed assistive personnel (UAP) who
notifies them a diabetic client is weak, tired, shaking, and has a rapid pulse. As the nurse enters the client's room, they see the UAP gently shaking the client and calling their name, but the client does not reply. Based on this information, the nurse should immediately. The nurse should prepare to .: Administer glucose Recheck the client's glucose
96. Which statement made by a client receiving teaching about managing their
20 / 30 diabetes mellitus (DM) type 1 with insulin indicates that more teaching is required?: "As long as I administer insulin and maintain a normal glucose, I can eat whatever I want."
97. Which classes of medication are used to treat diabetes mellitus (DM) type 2? Select
all that apply.: Sulfonylureas Dipeptidyl peptidase-IV (DPP-IV) inhibitors Thiazolidinediones Biguanides Glucagon-like peptide-1 (GLP-1) agonists
98. Which assessment data is most reliable for determining the effectiveness of
treatment in clients living with diabetes mellitus (DM) type 2?: Hemoglobin A1C (A1C)
99. Which class of medications is the first drug used to treat diabetes mellitus (DM)
type 2?: Biguanides
100. Clients taking medication to treat diabetes mellitus (DM) type 2 share which
primary treatment goal?: Hemoglobin A1C is less than 6.5%
101. A client with a new prescription for repaglinide tells the nurse that their eating
habits are irregular. They always eat at least two meals a day, just at dif- ferent times. The client is concerned about medication-related hypoglycemia if they wait to eat until they are at home and asks if they should ask the healthcare provider for different medication. What is the best response by the nurse?: "This medication works quickly and should be taken right before you eat. If you keep some with you, just take it 30 minutes before you eat."
102. What role does the enzyme dipeptidyl peptidase-IV (DPP-IV) have in the
digestion of complex carbohydrates?: Breaks down incretin
103. For each therapeutic effect given, specify if the therapeutic effect is associ- ated
with pramlintide (an amylin agonist) or liraglutide (an incretin mimetic). Each therapeutic
