Sherpath: Chapter 18, Drug Therapy for Diabetes: Drug Therapy for Diabetes Mellitus

Question 1 of 30

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Which action describes the action of insulin stimulators?

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  • Trigger beta cells to release more insulinInsulin stimulators trigger the release of already formed insulin from beta cells in the pancreas to lower blood glucose levels.
• • Decrease the amount of insulin receptors on cellsInsulin stimulators do not decrease the amount of insulin receptors on cells. They trigger the release of already formed insulin from beta cells to lower glucose levels.
• • Provide a synthetic source of insulinInsulin stimulators are not a synthetic source of insulin but stimulate insulin to be made available.
• • Cause insulin to be stored in the pancreasInsulin stimulators do not cause insulin to be created or stored in the pancreas, but to be more available for cells to use.

Question 2 of 30

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Which sign or symptom would indicate to the nurse that the administration of a patient’s insulin stimulator should be held? Select all that apply. One, some, or all responses may be correct.

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  • Feeling hungryFeeling a sensation of hunger, despite eating, is an indication of hypoglycemia, and the patient should not be given an insulin stimulator.
• Correct
  • Hand tremorsTremors are a symptom of hypoglycemia and giving a patient an insulin stimulator would be dangerous.
• Correct
  • Noticeable sweatingIncreased sweating, along with pale and clammy skin, are indications of hypoglycemia, and the patient should not be given an insulin stimulator.
• • Frequent urinationFrequent urination is a symptom of hyperglycemia, which would indicate that an insulin stimulator may be necessary.
• Correct
  • Difficulty concentratingAnxiety, confusion, and difficulty concentrating are all mental symptoms that a patient has hypoglycemia and should not be given an insulin stimulator.

Question 3 of 30

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Which instruction would the nurse include when teaching a patient about the administration of a sulfonylurea insulin stimulator? Select all that apply. One, some, or all responses may be correct.

• • “Take this medication on an empty stomach and wait an hour before eating a meal.”Insulin stimulators should be taken with a meal or no longer than 15 minutes prior to eating to prevent hypoglycemia.
• Correct
  • “It is not safe to take this medication with aspirin or an NSAID.”Aspirin and NSAIDs may enhance the hypoglycemic effect of insulin stimulators.
• Correct
  • “Be alert for symptoms of hypoglycemia when taking this medication.”An adverse effect of insulin stimulators is hypoglycemia, and the patient should be educated about the symptoms.
• • “Taking OTC cold medicine with pseudoephedrine along with this medication may cause hypoglycemia.”Pseudoephedrine can increase the risk of hyperglycemia, not hypoglycemia, by reducing the effectiveness of insulin stimulators.
• • “This drug reduces the effectiveness of some birth control pills in women.”Sulfonylurea insulin stimulators do not decrease the effectiveness of contraceptive drugs.

Question 4 of 30

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Which statement describes the mechanism of action of biguanides? Select all that apply. One, some, or all responses may be correct.

• Correct
  • Reduce the amount of glucose the liver releasesBiguanides lower blood glucose levels by reducing the amount of glucose the liver releases.
• Correct
  • Improve insulin binding to its cellular rector sitesBiguanides work by improving insulin binding to cellular receptor sites, thus allowing more insulin into the cells.
• • Cause the pancreas to release more insulinInsulin stimulators trigger the pancreas to release more insulin from beta cells. Biguanides do not stimulate the cause the pancreas to release more insulin.
• Correct
  • Slow the absorption of glucose from foodBiguanides work by reducing how much and how quickly the intestines absorb the glucose found in food.
• • Increase the amount of glucose that is available in the bloodBiguanides lower, not increase, the level of glucose in the blood.

Question 5 of 30

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Which sign or symptom of lactic acidosis would the nurse monitor for in a patient taking metformin? Select all that apply. One, some, or all responses may be correct.

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  • NauseaLactic acidosis resulting in a high concentration of lactate in the body can cause nausea.
• • Pale skinPale and clammy skin is a symptom of hypoglycemia, not lactic acidosis.
• Correct
  • Rapid breathingRapid, deep breathing is a symptom associated with lactic acidosis, which is an elevated concentration of lactate in the body.
• • DiarrheaA common side effect of metformin is diarrhea associated with gastrointestinal upset, but this does not indicate lactic acidosis
• • Blurred visionBlurred vision is a symptom of hyperglycemia, not lactic acidosis.

Question 6 of 30

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Which instruction would the nurse include when teaching a patient about the administration of metformin?

• • “If you need to have a diagnostic test with radioactive dye, stop taking this medication for two weeks.”Metformin interacts with the radioactive dye used in some diagnostic tests, leading to kidney failure, so metformin should be stopped at least 24 hours before the dye is used and not started again until 48 hours after the test is completed.
• • “This medication is not safe to use if you think you may be pregnant.”Metformin is considered safe for use during pregnancy for the treatment of gestational diabetes.
• • “You may experience weight gain with this medication.”Metformin may cause weight loss, not weight gain.
• Correct
  • “Take this medication with food to reduce gastrointestinal side effects.”Gastrointestinal side effects are common with metformin and include nausea, diarrhea, flatulence, and weight loss.

Question 7 of 30

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Which statement describes how rosiglitazone works in patients with diabetes mellitus?

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  • Makes insulin receptors more sensitive to insulinInsulin sensitizers, like rosiglitazone, lower blood glucose levels by making insulin receptors more sensitive to insulin, which increases cellular uptake and use of glucose.
• • Prevents carbohydrates from breaking down into glucoseAlpha-glucosidase inhibitors, not insulin sensitizers like rosiglitazone, prevent enzymes in the intestinal tract from breaking down starches and more complex sugars into glucose.
• • Stimulates the pancreas to secrete more insulinInsulin stimulators, not insulin sensitizers like rosiglitazone, work by triggering the beta cells in the pancreas to release more insulin.
• • Causes the liver to release less glucoseBiguanides, not insulin sensitizers like rosiglitazone, reduce the amount of glucose released by the liver and reduces how much and how quickly the intestines absorb the glucose in food.

Question 8 of 30

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Which condition is a side effect associated with the administration of rosiglitazone when combined with insulin?

• • Lactic acidosisLactic acidosis is associated with the use of biguanides. This is not a concern when combining rosiglitazone with insulin.
• • PancreatitisPancreatitis can occur in obese patients with DM type 2 taking incretin mimetics. This is not a concern when combining rosiglitazone with insulin.
• Correct
  • HypoglycemiaRosiglitazone has a potential side effect of low blood glucose level, resulting in hypoglycemia, especially if combined with insulin.
• • KetoacidosisKetoacidosis is associated with prolonged hyperglycemia. This is not a concern when combining rosiglitazone with insulin.

Question 9 of 30

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Which instruction would the nurse include when teaching a patient about the administration of an insulin sensitizer? Select all that apply. One, some, or all responses may be correct.

• • “This drug cannot be taken with insulin.”Insulin sensitizers are often used with other non-insulin antidiabetic drugs and can be taken with insulin for glycemic control.
• Correct
  • “Contact the healthcare provider if you notice swelling or rapid weight gain.”Patients taking an insulin sensitizer should be monitored for symptoms of heart failure, such as edema or weight gain. The patient would be counseled to inform the healthcare provider of these symptoms.
• • “Double up the next dose if you accidentally miss a dose.”If a dose of an insulin sensitizer is missed, it should be skipped, because doubling up a dose may cause adverse effects.
• Correct
  • “You may experience sneezing and a sore throat while taking this medication.”Headache, sneezing, and sore throat are expected side effects of insulin sensitizers.
• Correct
  • “This medication is only prescribed for type 2 diabetes mellitus.”Insulin sensitizers are used only to treat DM type 2, and they are often used together with other non-insulin anti-diabetic drugs.

Question 10 of 30

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Which statement describes how alpha-glucosidase inhibitors lower blood glucose levels?

• • Regulate the release of insulin into the bloodstreamInsulin stimulators lower blood glucose levels by encouraging the release of insulin from the pancreas.
• • Reduce the amount of glucose created in the liverBiguanides lower blood glucose levels by reducing the amount of glucose the liver releases.
• • Make cellular receptors more sensitive to insulinInsulin sensitizers lower blood glucose levels by making insulin receptors on cell membranes improve the uptake of insulin.
• Correct
  • Inhibit gastrointestinal enzymes from breaking down starches and complex sugarsAlpha-glucosidase inhibitors lowers blood glucose levels by preventing enzymes in the intestinal tract from breaking down starches and more complex sugars into glucose to slow glucose absorption.

Question 11 of 30

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Which condition can be worsened if the patient receives an alpha-glucosidase inhibitor? Select all that apply. One, some, or all responses may be correct.

• • Diabetes mellitus type 1Patients who have diabetes mellitus type 1 can be prescribed alpha-glucosidase inhibitors along with insulin. The patient’s diabetes is treated, not worsened, with alpha-glucosidase inhibitor therapy.
• Correct
  • Crohn’s diseaseAlpha-glucosidase inhibitors can cause the worsening of inflammatory bowel conditions such as Crohn’s disease.
• • Diabetes mellitus type 2Alpha-glucosidase inhibitors were initially approved to treat DM type 2 and can be combined with other anti-diabetic drugs. The patient’s diabetes is treated, not worsened, with alpha-glucosidase inhibitor therapy.
• Correct
  • ColitisAlpha-glucosidase inhibitors can cause the worsening of inflammatory bowel conditions such as colitis.
• • Hyperglycemia following mealsAlpha-glucosidase inhibitors are usually prescribed for patients who have high blood glucose levels after meals.

Question 12 of 30

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Which instruction would the nurse include when teaching a patient about the administration of an alpha-glucoside inhibitor? Select all that apply. One, some, or all responses may be correct.

• Correct
  • “Avoid drinking alcohol while taking this medication.”A patient should avoid alcohol because of the potential for liver impairment.
• • “Take this medication after eating a meal.”Alpha-glucosidase inhibitors are competitive inhibitors of the digestive enzymes, so they must be taken at the beginning of a meal.
• Correct
  • “This drug works best when combined with a proper diet and moderate exercise.”Alpha-glucosidase inhibitors slow down glucose absorption from food but work best when combined with a healthy lifestyle of a good diet and exercise.
• Correct
  • “Be alert for symptoms of hypoglycemia if taking other anti-diabetic drugs.”When alpha-glucoside inhibitors are combined with insulin other anti-diabetic drugs, there is a risk of hypoglycemia from blood glucose levels being too low.
• Correct
  • “Your gastrointestinal tract may need some time to adjust to the medication.”Alpha-glucosidase inhibitors prevent the breakdown of complex carbohydrates into glucose, so they remain in the intestine, and can initially cause gastrointestinal symptoms, such as flatulence, bloating, and diarrhea.

Question 13 of 30

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Which statement describes the action of incretin mimetics in a diabetic patient?

• • Increase cellular receptor uptake of insulinInsulin sensitizers, not incretin mimetics, increase the cellular uptake of insulin into the cells.
• • Prevent renal absorption of glucoseSodium-glucose cotransport inhibitors, not incretin mimetics, lower blood glucose by preventing the kidneys from absorbing glucose and allowing it to be excreted with the urine.
• • Prevent starches from breaking down into glucoseAlpha-glucosidase inhibitors, not incretin mimetics, work in the intestines to prevent starches and other complex carbohydrates from becoming glucose.
• Correct
  • Act like hormones in the intestines to increase insulin secretionIncretin mimetics mimic hormones in the small intestines that work along with insulin reduce blood glucose levels after meals by increasing insulin secretion, decreasing glucagon secretion, and slowing the rate of gastric emptying.

Question 14 of 30

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Which adverse effect is associated with incretin mimetics? Select all that apply. One, some, or all responses may be correct.

• • Cardiovascular diseaseCardiovascular disease is an adverse effect with other anti-diabetic drugs, such as DPP-4 inhibitors, not incretin mimetics.
• • Liver cancerIncretin mimetics increase the risk for thyroid cancer, not liver cancer.
• Correct
  • PancreatitisPancreatitis can occur in obese patients with DM type 2 who are on incretin mimetics over a long period of time.
• • Lactic acidosisLactic acidosis is an adverse reaction that is associated with biguanides, not incretin mimetics.
• Correct
  • Thyroid cancerThere is an increased risk of thyroid cancer, and patients on incretin mimetics should be monitored for lumps in the throat, difficulty swallowing, and other thyroid symptoms.

Question 15 of 30

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Which instruction would the nurse include when teaching a patient about weekly incretin mimetic injections? Select all that apply. One, some, or all responses may be correct.

• Correct
  • “This drug will help you feel full so you will likely eat less during meals.”Incretin mimetics provide satiety by slowing gastric emptying, which may help the patient to feel full longer and eat less.
• Correct
  • “This medication may affect the absorption other medications, such as birth control pills.”Incretin mimetics slow the absorption of many drugs, including birth control pills, so these should be taken 1 hour before the incretin mimetic.
• Correct
  • “A common side effect of this drug is weight loss.”Because incretin mimetics increase satiety with meals, patients often eat less and as a result lose weight on the medication.
• • “This medication is suitable for type 1 diabetics taking insulin.”Incretin mimetics are only approved for DM type 2 that is not controlled by other oral drugs.
• • “Inject this drug immediately after eating a meal.”Incretin mimetics should be injected 60 minutes before meals, and not after eating a meal to work properly.

Question 16 of 30

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Which mechanism of action occurs with the administration of amylin analog that results in reduced blood glucose levels?

• • Decrease of glucagon secretionIncretin mimetics, not amylin analogs, mimic hormones that result in a decrease of glucagon secretion.
• • Prevention of the metabolizing of carbohydratesAlpha-glucosidase inhibitors, not amylin analogs, prevent enzymes in the GI tract from breaking down carbohydrates into glucose.
• Correct
  • Delay of gastric emptyingAmylin analogs are similar to natural amylin, which is a hormone produced by pancreatic beta cells that is co-secreted with insulin in response to blood glucose elevation. It prevents hyperglycemia by delaying gastric emptying and making the patient feel full so that he or she eats less.
• • Reduction in the amount of glucose the liver releasesBiguanides, not amylin analogs, reduce the amount of glucose the liver releases and reduce how much and how quickly the intestines absorb glucose.

Question 17 of 30

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Which instruction would a nurse provide a patient taking pramlintide? Select all that apply. One, some, or all responses may be correct.

• Correct
  • “Keep injectable pens in the refrigerator and warm to room temperature before using.”Injectable pens of pramlintide should be kept refrigerated for longer shelf life, and they should be allowed to warm to room temperature before injecting.
• • “Mix this medication in a syringe with insulin for best results.”Although amylin is co-secreted with insulin by beta cells, it should not be mixed in the same syringe for injection.
• Correct
  • “Avoid drinking alcohol while taking this medication.”The patient should not drink alcohol while taking pramlintide to prevent adverse effects and liver damage.
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  • “Do not drive or operate machinery until you know how this drug affects you.”Pramlintide may cause dizziness, so a patient should not drive or operate machinery until they know if it will cause dizziness.
• Correct
  • “Inject this drug just prior to a meal.”For best results, pramlintide should be taken before eating because it delays gastric emptying.

Question 18 of 30

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Which adverse reaction is associated with pramlintide?

• • Weight gainAmylin analogs may cause weight loss, not weight gain.
• Correct
  • HypoglycemiaPramlintide has the adverse reaction of severe hypoglycemia, and this occurs most often within 3 hours after injection of the drug.
• • KetoacidosisKetoacidosis may occur when a patient has severe or prolonged hyperglycemia.
• • PancreatitisPancreatitis is associated with other non-insulin anti-diabetic drugs, such as incretin mimetics, not amylin analogs.

Question 19 of 30

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Which substance do DPP-4 inhibitors inhibit?

• • Insulin receptor sites on cellsInsulin sensitizers, not DPP-4 inhibitors, work by making insulin receptor sites more sensitive to increase the uptake of insulin into cells.
• • Hormones produced by beta cellsAmylin analogs, not DPP-4 inhibitors, are similar to amylin that is produced by beta cells and works alongside insulin.
• Correct
  • Enzymes that suppress incretinsDPP-4 inhibitors are non-insulin antidiabetic drugs that help prevent hyperglycemia by reducing the amount of the enzyme DPP-4, which inactivates the normal incretins, GLP and GIP. This action allows the naturally produced incretins to be present and work with insulin to control blood glucose levels.
• • Glucose released by the liverBiguanides, not DPP-4 inhibitors, reduce the amount of glucose released by the liver.

Question 20 of 30

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For which adverse reaction would the nurse assess a patient taking a DPP-4 inhibitor? Select all that apply. One, some, or all responses may be correct.

• Correct
  • Facial swellingBecause allergic reactions are associated with DPP-4 inhibitors, a patient should be assessed for signs of allergic reaction, including swelling of the face, tongue, mouth, larynx, or hives.
• Correct
  • Fluid-filled blistersBullous pemphigoida, a rare skin condition that results in large, fluid-filled blisters on the lower abdomen, upper thighs, or armpits, is a potential adverse reaction.
• Correct
  • Clammy skinPale, clammy skin is a symptom of hypoglycemia, which is an adverse reaction of DPP-4 inhibitors, especially if they are given in combination with insulin or a sulfonylurea.
• • Increased thirstIncreased thirst is a symptom of hyperglycemia, which DPP-4 inhibitors are used to treat.
• Correct
  • Upper abdominal painPancreatitis is associated with DPP-4 inhibitors and can result in severe upper abdominal pain.

Question 21 of 30

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Which drug interaction is associated with DPP-4 inhibitors?

• • Birth control pillsIncretin mimetics, not DPP-4 inhibitors, slow the absorption of drugs, such as contraceptives, so caution should be taken when combining birth control pills with incretin mimetics.
• Correct
  • ErythromycinThe effectiveness of DPP-4 inhibitors may be reduced when they are given in combination with a strong P-glycoprotein inducer, such as the antibiotic erythromycin.
• • Antihypertensive drugsAntihypertensive drugs interact with insulin sensitizers, not DPP-4 inhibitors.
• • Radioactive dyesBiguanides, not DPP-4 inhibitors, interact with diagnostic radioactive dye.

Question 22 of 30

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Which action describes how sodium-glucose cotransport inhibitors work?

• • Increasing the release of insulin from the pancreasInsulin stimulators, not sodium-glucose cotransport inhibitors, trigger the release of preformed insulin from beta cells to reduce blood glucose levels.
• • Delaying the rate of gastric emptying after mealsOther anti-diabetic drugs, such as incretin mimetics, slow down the rate of gastric emptying to control blood glucose levels. This is not the mechanism of action for sodium-glucose cotransport inhibitors.
• • Inhibiting gastrointestinal enzymes that inactivate incretinsDPP-4 inhibitors, not sodium-glucose cotransport inhibitors, work by inhibiting gastrointestinal enzymes that inactivate incretins, which work with insulin to control blood glucose levels.
• Correct
  • Preventing kidneys from reabsorbing glucose filtered out by the bloodSodium-glucose cotransport inhibitors work by preventing the kidney from reabsorbing glucose that was filtered from the blood into the urine, so the glucose remains in the urine and is eventually excreted.

Question 23 of 30

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When teaching a patient a patient about the administration of a sodium-glucose cotransport inhibitor, which side effect would the nurse include? Select all that apply. One, some, or all responses may be correct.

• • DizzinessDizziness is a side effect that is associated with the amylin analog, pramlintide, not sodium-glucose cotransport inhibitors.
• Correct
  • Weight lossWeight loss occurs in patients taking sodium-glucose cotransport inhibitors initially in fluid loss, then in fat mass loss.
• • DiarrheaGastrointestinal upset, including diarrhea, side effects of other anti-diabetic drugs, such as biguanides, alpha-glucosidase inhibitors, and sulfonylureas. This is not a side effect associated with sodium-glucose cotransport inhibitors.
• Correct
  • Frequent urinationFrequent urination is an expected side effect of sodium-glucose cotransport inhibitors as they work to remove glucose from the body through the urine.
• • Runny noseNasopharyngitis with cold-like symptoms of a runny nose are side effects of other anti-diabetic drugs, such as DPP-4 inhibitors, incretin mimetics, and insulin sensitizers, not sodium-glucose cotransport inhibitors.

Question 24 of 30

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Which instruction would a nurse provide a patient taking a sodium-glucose cotransport inhibitor? Select all that apply. One, some, or all responses may be correct.

• • “Use a urine glucose test strip to assess your glucose level.”Patients will notice the presence of glucose in urine with a glucose test strip because sodium-glucose cotransport inhibitors work by excreting glucose into the urine for elimination. As such, the test will always be positive and is not used to assess glucose levels.
• Correct
  • “Be alert for symptoms of a urinary tract infection.”A patient should be alert for the symptoms of UTI, urgency, burning, painful urination, bloody or dark-colored urine, fever, chills, and back pain because UTIs are an adverse reaction of sodium-glucose cotransport inhibitors.
• Correct
  • “Do not combine this drug with a diuretic.”If sodium-glucose cotransport inhibitors are combined with diuretics, the frequency of urination increases, and dehydration can result.
• Correct
  • “Watch for signs of muscle weakness and cramping while taking this medication.”Sodium-glucose cotransport inhibitors can cause hyponatremia, characterized by muscle weakness, abdominal cramping, rapid heart rate, and orthostatic hypotension, because these drugs increase sodium loss.
• • “Expect this medication to cause some gastrointestinal upset.”Gastrointestinal upset is not associated with sodium-glucose cotransport inhibitors, but it may occur with other anti-diabetic drugs, such as alpha-glucosidase inhibitors.

Question 25 of 30

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Which role does insulin play in the body? Select all that apply. One, some, or all responses may be correct.

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  • Allows glucose to pass into cells easierInsulin causes reactions to occur on the cell membrane that allow glucose to pass into cells easier, which maintains proper blood glucose levels.
• • Encourages the liver to release glucoseInsulin does not encourage the liver to release glucose.
• Correct
  • Inhibits release of fatty acids in the bloodAdequate amounts of insulin inhibit the release of fatty acids into the blood, preventing high blood lipid levels.
• Correct
  • Binds to receptors on cell membranesBeta cells in the pancreas release insulin, which binds to insulin receptor sites on cell membranes.
• Correct
  • Helps maintain adequate stores of glycogenInsulin plays an important role in fat metabolism, helping to prevent high lipid levels and maintaining stores of fatty acids, glycogen, and protein.

Question 26 of 30

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Which risk is associated with administering insulin?

• • A dose that is too low in a patient with diabetes can result in dangerously low blood glucose levels.If insulin is given at too low a dose to a patient with diabetes, the patient’s blood glucose level will be poorly controlled, increasing the risk of severe hyperglycemia.
• Correct
  • A patient without diabetes can become severely hypoglycemic if given any amount insulin.If insulin is administered to a patient who does not have diabetes, insulin administration may cause dangerously low blood glucose levels with a risk of death.
• • A dose that is too high in a patient with diabetes can cause severe ketoacidosis.If insulin is given at too high a dose to a patient with diabetes, the patient can become severely hypoglycemic, possibly even causing death.
• • A patient who has DM type 2 and receives insulin can become dangerously hyperglycemic.Some patients with DM type 2 whose bodies no longer produce insulin may require insulin, and it is not harmful.

Question 27 of 30

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Which drug or drug class interacts with insulin? Select all that apply. One, some, or all responses may be correct.

• Correct
  • Anabolic steroidsAnabolic steroids can increase the hypoglycemic effects of insulin, resulting in a higher risk of severe hypoglycemia.
• Correct
  • Thiazide diureticsThiazide diuretics are insulin antagonists. They can increase a patient’s insulin needs.
• Correct
  • ContraceptivesContraceptives are insulin antagonists and can counteract its effects.
• • Amylin analogsAn amylin analog works with insulin and can be taken by patients who have DM type 1.
• Correct
  • EpinephrineEpinephrine is an insulin antagonist and can make it less active when combined with insulin.

Question 28 of 30

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Which guideline would the nurse follow when administering insulin to a patient?

• • Refrigerate until ready to inject.Insulin does not need to be refrigerated and should not be administered cold.
• • Shake the vial to mix the insulin.Insulin vials should not be shaken, but gently rolled in the hands, to prevent air bubbles and protein molecules from breaking.
• • Position needle at a 45-degree angle.An injection should be given at a 90-degree, not 45-degree, angle into a skin fold.
• Correct
  • Rotate injection sites.Lipodystrophy is abnormal fat distribution that resembles a small lump or nodule from repeated injections in the same area and can be avoided by rotating the injection sites.

Question 29 of 30

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Which instruction would the nurse include when teaching a patient about the administration of insulin? Select all that apply. One, some, or all responses may be correct.

• • “Do not eat anything for 30 minutes after taking a short-acting insulin dose.”Short-acting insulin is administered before a snack or meal, and the patient needs to eat the snack or meal within 15 minutes of receiving the injection to prevent hypoglycemia.
• Correct
  • “Be sure to maintain a log of your glucose testing results.”Patients need to perform home glucose testing and maintain a record of their test results that can be used by the healthcare provider to adjust the insulin regimen.
• • “Insulin cannot be taken if you are pregnant or think you may become pregnant.”Insulin is prescribed for patients who are pregnant and may be given instead of other non-insulin anti-diabetic drugs to patients who have diabetes and are pregnant or may become pregnant.
• Correct
  • “Inject a dosage into your abdomen, thigh, or upper armPatients should use a syringe designed specifically for insulin dosage injecting the insulin subcutaneously into the thigh, upper arm, or abdomen for best absorption.
• Correct
  • “Do not skip meals while taking this medication.”Hypoglycemia may develop from skipping a meal or illness associated with vomiting or diarrhea, and this can lead to severe illness or death.

Question 30 of 30

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Which instruction would a nurse provide to a patient using an insulin pen? Select all that apply. One, some, or all responses may be correct.

• Correct
  • “Wipe the tip of the pen with an alcohol swab before attaching the needle.”The patient should wipe the tip of the pen where the needle will attach with an alcohol swab to cleanse the area.
• Correct
  • “Always be sure to verify the dosage window on the pen before injecting.”The patient should check the dose window on the pen device, turning the device knob to the appropriate dose to avoid over- or under dosing.
• • “Place the pen at a 30-degree angle to the skin for injection.”The patient should hold the pen with the needle pointing at a 90-degree angle to the skin, not 30 degrees.
• Correct
  • “Hold the pen in place for 6–10 seconds after depressing the dosing button.”The patient should hold the pen in place over the desired injection site for 6–10 seconds before withdrawing it for the insulin to fully inject.
• Correct
  • “Dispose of the needle in a hard plastic container.”The patient should replace the outer needle cap, unscrew to remove the needle, and dispose of the needle in a hard plastic or metal container to prevent injury.