NUR 354 Exam 4 UPDATED ACTUAL Questions and CORRECT
Answers
DM education - pharmacological interventions, nutrition management, patient education and
self-management, and detection and prevention of complications.
- Insulin administration: rotating sites (arm to abdomen), angle of injection
(fatter 90 degrees, 45 degrees if unable to pinch fat)
- Family teaching: signs of hyperglycemia and hypoglycemia
DM labs Glucose and A1C
Insulin peak, onset, duration See table 45.1
What should you monitor before and after Glucose
administration of insulin
How do you mix insulins in one syringe? 1. Gather supplies
2. Verify orders
3. 6 rights
4. Roll vials to mix
5. Clean the tops with alcohol
6. Put air into NPH insulin (Do not touch medication)
7. Put air into regular insulin and draw up regular insulin
8. Draw up NPH insulin
How do you administer insulin? Subcutaneously, rotate injection sites arm to abdomen.
What insulins can be mixed? NPH with rapid/short acting insulin (aspart, lispro, glulisine, regular)
What insulins can be administered IV? Insulin R
Side effects of insulin? hypoglycemia (tachycardia, confusion, sweating, and drowsiness), weight gain
metformin side effects nausea, vomiting, abdominal discomfort, metallic taste, diarrhea, and anorexia.
headache, dizziness, agitation, and fatigue. Blackbox: lactic acidosis
metformin education - Extended-release tablets must be swallowed whole and not crushed or
chewed.
- Fasting blood glucose levels should be obtained every 3 months, and the
dose adjusted accordingly.
- Discontinue the medication immediately if signs of acidosis are present
metformin labs to monitor glucose
how does metformin work? reduces fasting and postprandial glucose levels
by decreasing the hepatic production of glucose (gluconeogen-esis) and
reducing insulin resistance.
GLP1 receptor agonist Exenatide, liraglutide
GLP1 receptor agonist action
, GLP1 receptor agonist side effects Nausea, vomiting, diarrhea, nervousness, injection site reactions
GLP1 receptor agonist administration
SGLT2 inhibitors Canagliflozin (Invokana)
Dapagliflozin (Farxiga)
Empagliflozin (Jardiance)
SGLT2 inhibitors action They get excreted through urine; kidneys excrete glucose through the urine.
Promote weight loss.
SGLT2 inhibitors side effects Female genital mycotic infections, urinary tract infection, and nasopharyngitis
SGLT2 inhibitors administration subq, predose pen weekly/daily
DPP-4 inhibitors Linagliptin, saxagliptin, sitagliptin
DPP-4 inhibitors action
DPP-4 inhibitors side effects Flulike symptoms, upper respiratory infection, back pain
Hypoglycemia
DPP-4 inhibitors administration PO
Adrenal insufficiency diagnosis ACTH stimulation test- Cosyntropin is injected to IV and plasma cortisol levels
are measured 30-60 minutes later. If the adrenal gland responds by secreting
corticosteroids after the cosyntropin injection, the pathology lies at the level of
the pituitary or hypothalamus (secondary adrenocortical insufficiency).
adrenal insufficiency lab, what you monitor ACTH
Thyroids disorders- labs to check t3 and t4, TSH
Levothyroxine education take in the morning at the same time every day
Levothyroxine side effects palpitations, dysrhythmias, anxiety, insomnia, weight loss, heat intolerance,
menstrual irregularities
Levothyroxine Contraindications use for obesity or weight loss is contraindicated
Levothyroxine use low thyroid function
Levothyroxine- labs to monitor t3, t4, TSH
radioactive iodine-whats is it used for? destroys part of the thyroid gland (ablation) to lower thyroid secretion
Lugol's solution- use and when we use it thyroid storm, mainly used to supress thyroid 10-14 days prior to thyroidectomy
Thyroid storm symptoms tachycardia, hyperthermia, chest pain, sweating, weakness, heart failure,
anxiety, shortness of breath, disorientation
Hashimoto's symptoms intolerance to cold
Answers
DM education - pharmacological interventions, nutrition management, patient education and
self-management, and detection and prevention of complications.
- Insulin administration: rotating sites (arm to abdomen), angle of injection
(fatter 90 degrees, 45 degrees if unable to pinch fat)
- Family teaching: signs of hyperglycemia and hypoglycemia
DM labs Glucose and A1C
Insulin peak, onset, duration See table 45.1
What should you monitor before and after Glucose
administration of insulin
How do you mix insulins in one syringe? 1. Gather supplies
2. Verify orders
3. 6 rights
4. Roll vials to mix
5. Clean the tops with alcohol
6. Put air into NPH insulin (Do not touch medication)
7. Put air into regular insulin and draw up regular insulin
8. Draw up NPH insulin
How do you administer insulin? Subcutaneously, rotate injection sites arm to abdomen.
What insulins can be mixed? NPH with rapid/short acting insulin (aspart, lispro, glulisine, regular)
What insulins can be administered IV? Insulin R
Side effects of insulin? hypoglycemia (tachycardia, confusion, sweating, and drowsiness), weight gain
metformin side effects nausea, vomiting, abdominal discomfort, metallic taste, diarrhea, and anorexia.
headache, dizziness, agitation, and fatigue. Blackbox: lactic acidosis
metformin education - Extended-release tablets must be swallowed whole and not crushed or
chewed.
- Fasting blood glucose levels should be obtained every 3 months, and the
dose adjusted accordingly.
- Discontinue the medication immediately if signs of acidosis are present
metformin labs to monitor glucose
how does metformin work? reduces fasting and postprandial glucose levels
by decreasing the hepatic production of glucose (gluconeogen-esis) and
reducing insulin resistance.
GLP1 receptor agonist Exenatide, liraglutide
GLP1 receptor agonist action
, GLP1 receptor agonist side effects Nausea, vomiting, diarrhea, nervousness, injection site reactions
GLP1 receptor agonist administration
SGLT2 inhibitors Canagliflozin (Invokana)
Dapagliflozin (Farxiga)
Empagliflozin (Jardiance)
SGLT2 inhibitors action They get excreted through urine; kidneys excrete glucose through the urine.
Promote weight loss.
SGLT2 inhibitors side effects Female genital mycotic infections, urinary tract infection, and nasopharyngitis
SGLT2 inhibitors administration subq, predose pen weekly/daily
DPP-4 inhibitors Linagliptin, saxagliptin, sitagliptin
DPP-4 inhibitors action
DPP-4 inhibitors side effects Flulike symptoms, upper respiratory infection, back pain
Hypoglycemia
DPP-4 inhibitors administration PO
Adrenal insufficiency diagnosis ACTH stimulation test- Cosyntropin is injected to IV and plasma cortisol levels
are measured 30-60 minutes later. If the adrenal gland responds by secreting
corticosteroids after the cosyntropin injection, the pathology lies at the level of
the pituitary or hypothalamus (secondary adrenocortical insufficiency).
adrenal insufficiency lab, what you monitor ACTH
Thyroids disorders- labs to check t3 and t4, TSH
Levothyroxine education take in the morning at the same time every day
Levothyroxine side effects palpitations, dysrhythmias, anxiety, insomnia, weight loss, heat intolerance,
menstrual irregularities
Levothyroxine Contraindications use for obesity or weight loss is contraindicated
Levothyroxine use low thyroid function
Levothyroxine- labs to monitor t3, t4, TSH
radioactive iodine-whats is it used for? destroys part of the thyroid gland (ablation) to lower thyroid secretion
Lugol's solution- use and when we use it thyroid storm, mainly used to supress thyroid 10-14 days prior to thyroidectomy
Thyroid storm symptoms tachycardia, hyperthermia, chest pain, sweating, weakness, heart failure,
anxiety, shortness of breath, disorientation
Hashimoto's symptoms intolerance to cold
