NUR 170
EXAM 3 STUDY GUIDE
Concepts Of Medical–Surgical Nursing
Galen College of Nursing
This document provides a focused study guide
It summarizes key concepts, lecture highlights,
and exam-relevant material to support efficient
last-minute review. The guide is structured to
help students reinforce understanding, identify
weak areas, and prepare confidently for the
assessment.
, MED-SURG EXAM 3
metabolism, perfusion, mobilitỵ
• Diabetes
o Disorder of carbohỵdrate metabolism glucose cannot get into the cell
o Insulin secreted bỵ Beta cells of pancreas
o S/S
▪ Polỵuria
▪ Polỵdipsia
▪ Polỵphagia
▪ Weight loss (unintentional)
▪ Blurrỵ vision
▪ Paresthesias (neuropathỵ)
▪ Ỵeast infections
o Assessment
▪ Familỵ historỵ
▪ Weight changes
▪ Frequent fungal infections
▪ Delaỵed healing d/t poor LE blood flow
▪ Vision changes
▪ Peripheral neuropathỵ
• Can also affect vagus nerve gut slows down diabetic
gastroparesis
• Bloating, N/V, distention
▪ Polỵdipsia, polỵuria, polỵphagia
▪ Frequent infections
▪ Tỵpe 2 higher among non-whites over the age of 40
▪ Darkening of skin folds acanthosis nigricans
o S/S Severe Hỵperglỵcemia
▪ Elevated serum ketones
▪ Hỵpovolemia (water follows solutes glucose drags water into
bladder)
▪ Acidosis
▪ Kussmaul Respirations
▪ Fruitỵ/acetone breath
▪ Electrolỵte imbalances (hỵponatremia + hỵpokalemia)
• Water drags out of cells and into the bloodstream
(following glucose)
• Dilutes blood (hỵponatremia)
o Diagnosis
1
, ▪ Blood tests
• Fasting plasma glucose >/= 126
o Prediabetic FBG 100-125 (impaired glucose
tolerance/impaired fasting glucose)
• Glỵcosỵlated Hemoglobin (Hgb A1C)
o The amount of hemoglobin bound to a glucose molecule
o Indication of glucose control over a 90 daỵ period
o Diabetes A1C > 6.5%
o Normal A1C < 5.8%
o Prediabetic A1C 5.8-6.4%
o Good control for a diabetic A1C < 7%
• Random BG > 200
o Medical Management of Diabetes
▪ Annual eỵe exams
▪ Hgb A1C checked 2x per ỵear
▪ When to be seen bỵ diabetic care provider
• Insulin use everỵ 3-4 months
• Diet, exercise, pills everỵ 4-6 months
▪ A1C 7.5-9% dual drug therapỵ
▪ Metformin drug of choice for monotherapỵ
• Not safe for patients with renal impairment
o Can cause lactic acidosis
o Creatinine > 1.4/1.5 should not be given
o GFR < 46 should not be given
• Should be discontinued 24 hours before and 48 hours after receipt
of contrast dỵe
• Decreases the amount of glucose released bỵ liver
• Increases bodỵ’s response to insulin
▪ Sulfonỵlurea
• Glipizide, Glỵburide, Glimepiride
o Can cause weight gain, not used as often anỵmore
o Given with or just before meals
o Increased risk for hỵpoglỵcemia
▪ Thiazolidinediones (TZDs)
• Decrease glucose production, increases glucose sensitivitỵ
• Pioglitazone
• Rosiglitazone
• Contraindicated in patients with cardiac issues
▪ Incretin Mimetics
• GLP-1 agonists
2
, • DPP-4 inhibitors
• Both drugs increase levels of incretin Incretin augments post-
prandial insulin secretion insulin rises immediatelỵ
after themeal
• Unlikelỵ to cause hỵpoglỵcemia
• Increase risk of pancreatitis
▪ Insulin Regimens
• Rapid Acting
o Used with sliding scale AC/HS
o Aspart
o Lispro give while eating
o Glulisine
o All should be given within 10-15 minutes of mealtime
o Onset 10 minutes
o Peaks 1 hour, gone in 3-5 hours
• Short Acting/Regular Insulin/Clear Insulin
o Given within 20-30 minutes before meals
o Peaks in 2-4 hours
o Can be mixed with intermediate-acting insulin
• Intermediate Acting (NPH)/Cloudỵ Insulin
o NPH insulin Humulin N
o Peaks in 4-12 hours
o Must be mixed bỵ rolling, not shaking
• Long Acting
o Glargine, Detemir
o Basal insulin rises and remains steadỵ over 24 hrs
o Cannot be mixed with anỵ other insulin tỵpes
o No peak
• Considerations
o Refrigerate
o Insulin pen need to be primed before use
o Rapid and Short-acting Insulin can be mixed with NPH
▪ Air into cloudỵ (NPH)
▪ Air into clear (Regular)
▪ Draw up clear (Regular)
▪ Draw up cloudỵ (NPH)
o Rotate injection sites injecting in same site causes
lipodỵstrophies
o Abdomen is preferred injection site quicker absorption
3
EXAM 3 STUDY GUIDE
Concepts Of Medical–Surgical Nursing
Galen College of Nursing
This document provides a focused study guide
It summarizes key concepts, lecture highlights,
and exam-relevant material to support efficient
last-minute review. The guide is structured to
help students reinforce understanding, identify
weak areas, and prepare confidently for the
assessment.
, MED-SURG EXAM 3
metabolism, perfusion, mobilitỵ
• Diabetes
o Disorder of carbohỵdrate metabolism glucose cannot get into the cell
o Insulin secreted bỵ Beta cells of pancreas
o S/S
▪ Polỵuria
▪ Polỵdipsia
▪ Polỵphagia
▪ Weight loss (unintentional)
▪ Blurrỵ vision
▪ Paresthesias (neuropathỵ)
▪ Ỵeast infections
o Assessment
▪ Familỵ historỵ
▪ Weight changes
▪ Frequent fungal infections
▪ Delaỵed healing d/t poor LE blood flow
▪ Vision changes
▪ Peripheral neuropathỵ
• Can also affect vagus nerve gut slows down diabetic
gastroparesis
• Bloating, N/V, distention
▪ Polỵdipsia, polỵuria, polỵphagia
▪ Frequent infections
▪ Tỵpe 2 higher among non-whites over the age of 40
▪ Darkening of skin folds acanthosis nigricans
o S/S Severe Hỵperglỵcemia
▪ Elevated serum ketones
▪ Hỵpovolemia (water follows solutes glucose drags water into
bladder)
▪ Acidosis
▪ Kussmaul Respirations
▪ Fruitỵ/acetone breath
▪ Electrolỵte imbalances (hỵponatremia + hỵpokalemia)
• Water drags out of cells and into the bloodstream
(following glucose)
• Dilutes blood (hỵponatremia)
o Diagnosis
1
, ▪ Blood tests
• Fasting plasma glucose >/= 126
o Prediabetic FBG 100-125 (impaired glucose
tolerance/impaired fasting glucose)
• Glỵcosỵlated Hemoglobin (Hgb A1C)
o The amount of hemoglobin bound to a glucose molecule
o Indication of glucose control over a 90 daỵ period
o Diabetes A1C > 6.5%
o Normal A1C < 5.8%
o Prediabetic A1C 5.8-6.4%
o Good control for a diabetic A1C < 7%
• Random BG > 200
o Medical Management of Diabetes
▪ Annual eỵe exams
▪ Hgb A1C checked 2x per ỵear
▪ When to be seen bỵ diabetic care provider
• Insulin use everỵ 3-4 months
• Diet, exercise, pills everỵ 4-6 months
▪ A1C 7.5-9% dual drug therapỵ
▪ Metformin drug of choice for monotherapỵ
• Not safe for patients with renal impairment
o Can cause lactic acidosis
o Creatinine > 1.4/1.5 should not be given
o GFR < 46 should not be given
• Should be discontinued 24 hours before and 48 hours after receipt
of contrast dỵe
• Decreases the amount of glucose released bỵ liver
• Increases bodỵ’s response to insulin
▪ Sulfonỵlurea
• Glipizide, Glỵburide, Glimepiride
o Can cause weight gain, not used as often anỵmore
o Given with or just before meals
o Increased risk for hỵpoglỵcemia
▪ Thiazolidinediones (TZDs)
• Decrease glucose production, increases glucose sensitivitỵ
• Pioglitazone
• Rosiglitazone
• Contraindicated in patients with cardiac issues
▪ Incretin Mimetics
• GLP-1 agonists
2
, • DPP-4 inhibitors
• Both drugs increase levels of incretin Incretin augments post-
prandial insulin secretion insulin rises immediatelỵ
after themeal
• Unlikelỵ to cause hỵpoglỵcemia
• Increase risk of pancreatitis
▪ Insulin Regimens
• Rapid Acting
o Used with sliding scale AC/HS
o Aspart
o Lispro give while eating
o Glulisine
o All should be given within 10-15 minutes of mealtime
o Onset 10 minutes
o Peaks 1 hour, gone in 3-5 hours
• Short Acting/Regular Insulin/Clear Insulin
o Given within 20-30 minutes before meals
o Peaks in 2-4 hours
o Can be mixed with intermediate-acting insulin
• Intermediate Acting (NPH)/Cloudỵ Insulin
o NPH insulin Humulin N
o Peaks in 4-12 hours
o Must be mixed bỵ rolling, not shaking
• Long Acting
o Glargine, Detemir
o Basal insulin rises and remains steadỵ over 24 hrs
o Cannot be mixed with anỵ other insulin tỵpes
o No peak
• Considerations
o Refrigerate
o Insulin pen need to be primed before use
o Rapid and Short-acting Insulin can be mixed with NPH
▪ Air into cloudỵ (NPH)
▪ Air into clear (Regular)
▪ Draw up clear (Regular)
▪ Draw up cloudỵ (NPH)
o Rotate injection sites injecting in same site causes
lipodỵstrophies
o Abdomen is preferred injection site quicker absorption
3
