Medical-Surgical Nursing Final.
A Comprehensive Exam Study Guide
With 100% Certified Answers by Experts.
Latest Updated Guide 2025/2026.
lispro insulin (humulog) - ansrapid acting insulin
onset of lispro insulin (humolog) - ansunder 15 minutes
peak of lispro insulin (humulog) - ans30 min to 1.5 hours
when to administer lispro insulin (humulog) - ans0-15 minutes prior to a meal
regular insulin (Humulin R, Novolin R) - ansshort acting insulin
onset of regular insulin (humulin R, Novolin R) - ans30 min to 60 minutes
peak of regular insulin (humulin R, Novolin R) - ans2 to 3 hours
when to administer regular insulin (humulin R, Novolin R) - ans30 minutes before a meal
lente insulin (humulin L) - ansintermediate acting insulin
onset of lente insulin - ans1 to 2 hours
when to administer lente insulin - ansdoes not need to be with a meal
peak of lente insulin - ans4 to 12 hours
insulin glargine - anslong acting insulin
precautions with insulin glargine (lantus) - ansinsulin glargine cannot be mixed with other
insulins!!, the action may be affected in an unpredictable manner.
onset of insulin glargine - ans1-1.5 hours
peak of insulin glargine - anshas no peak...lasts 24 hr
storage for insulin - ansinsulin vials should be stored in a refrigerator or they can be kept at
room temperature for up to 28 days. cartridges and pens should be stored at room temperature
and used within 28 days..
glucagon - ansa drug used to treat hypoglycemia. raises blood glucose levels
side effects of glucagon - ansn/v, hypotension, hypersensitivity, & hypokalemia
administration of glucagon - anscan be given SQ, IM, or IV. then as soon as the patient is
awake, give the patient some carbohydrate snack
mixing insulin - answhenever mixing insulin, the short acting (regular/humilin R) insulin is
drawn up first in order to prevent contamination. short acting is clear insulin and intermediate
acting (humilin L/lente) is cloudy, so it is drawn up clear then cloudy. insulin glargine cannot
be mixed with any kind of insulin.
metformin - ansthe most common oral hypoglycemic medication for pre diabetic patients and
non insulin dependent type 2 diabetes. is not used to treat type 1.
administration of metformin - anstaken each day. administer WITH food in order to prevent
GI upset. also take vitamin B12 and folic acid supplements
side effects of metformin - ansGI effects including anorexia, n/v, HA, abdominal gas/pain,
metallic taste, hypoglycemia,
LACTIC ACIDOSIS!! (unexplained muscle aches, fatigue, lethargy and hyperventilation)
*ok for pregnancy
precautions taking metformin - ansneeds to be stopped 48 hours before any type of
radiographic test with iodinated contrast dye and can't be resumed until 48 hours after
because this can cause lactic acidosis or ARF. watch renal function when taking metformin.
,Medical-Surgical Nursing Final.
A Comprehensive Exam Study Guide
With 100% Certified Answers by Experts.
Latest Updated Guide 2025/2026.
when to d/c metformin - ansimmediately if unexplained hypoxemia, dehydration, or signs of
lactic acidosis
what foods increase risk of hypoglycemia with oral anti diabetic drugs - anscelery, coriander,
dandelion root, garlic, ginseng
Diabetes mellitus - ansis a systemic, chronic, and progressive metabolic disease that requires
lifelong lifestyle modification. people with DM have the inability to metabolize
carbohydrates, proteins, and fats
Type 1 DM - anscan be genetic or autoimmune. involves the destruction of pancreatic beta
cells. has no or minimal insulin production.
aka Juvenile onset/ IDDM
Type 2 DM - anscan be genetic and environmental. either d/t desensitization (limited
response by beta cells) or insulin resistance (liver and peripheral tissues).
aka Adult onset/ NDDM
Type 1: age of onset, symptoms, insulin production, BMI, and insulin mgt - ansAge: <30 but
can occur at any age.
S/sx: abrupt onset, weight loss
Insulin production: None, no prevention.
BMI: usually non-obese
Insulin: dependent
Type 2: age of onset, symptoms, insulin production, BMI, and insulin mgt - ansAge: peak at
50 yo
S/sx: slow onset, fatigue
Insulin production: low, normal, or high. Preventable.
BMI: 60-80% of type 2 pts are obese
Insulin: 20-30% require
diabetic ketoacidosis - ansa complication of diabetes.. is a lack of insulin and ketosis.
more common in Type 1
hyperglycemia-hyperosmolar state - ansa complication of diabetes... is an insulin deficiency
and profound dehydration
hypoglycemia - ansa complication of diabetes... is too little insulin, too little glucose
s/sx of diabetes - ans3 p's (polyuria, polydipsia, polyphagia), unintended weight loss, fatigue
& weakness, irritability & mood changes, blurred vision, slow healing sores, acanthuses
nigricans, HTN, hyperlipidemia, liver impairment, frequent infections
complications of DM - ansretinopathy, nephropathy, neuropathy, CAD/CVD risk of stroke,
PVD
acanthosis nigricans - ansskin changes with DM2. skin folds around neck and armpits
HBA1C pre diabetes - ans5.7-6.4 %
HBA1C diabetes - ans> 6.5 %
goal is to be below 7 % for diabetics.
Fasting plasma glucose (FPG) - ans> 126 mg/dl
,Medical-Surgical Nursing Final.
A Comprehensive Exam Study Guide
With 100% Certified Answers by Experts.
Latest Updated Guide 2025/2026.
would be 8+ hours fasting, taken in the morning
Normal FPG for non diabetics - ans< 90
Oral Glucose Tolerance Test (OGTT) - ans> 200 mg/dl after 2 hours
-have patient drink several surgery drinks and take the BG and see how its tolerated?
**check ATI
Random serum glucose - ans> 200 mg/dl
CBC - ansinfection, anemia
CMP - anselectrolytes, liver, and renal function
Lipid panel - ansto show CVD risk
urine micro albumin - ansto show protein in the urine, indicates renal failure
other labs for DM 1 - ansantigens & antibodies for DM 1
Interventions for Pre-diabetics - ansgoal is for HBA1c to be < 6
-lifestyle modifications: weight loss of 7 % of body weight, exercise 150 min/week
-meformin therapy IF BMI > 35
-might have blood glucose monitoring
Interventions for Type 1 Diabetics - ansGoal is for HBA1C to be < 7
-lifestyle modification
-insulin therapy is LIFELONG
-basal insulin (short acting-sliding scale and intermediate acting)
-blood glucose monitoring
Interventions for Type 2 Diabetics - ansGoal is for HBA1C to be < 7
-lifestyle modifications
-try oral hypoglycemic agent 1st
-Insulin is possible tmt
-blood glucose monitoring
Nutritional interventions for diabetes - anspts should have medical nutrition therapy initially
after dx every 3 months. monitor eating patterns, carb counting/quality, dietary fat & protein,
supplements, decrease alcohol and sodium, increase fiber, consult with nutritionist.
GOAL = GLYCEMIC CONTROL (dec. HbA1C)
Education for diabetes patients - ansself management, medications, physical activity,
nutrition, hypoglycemia, blood sugar testing, follow up appts/HCP, immunizations: flu,
pneumonia, shingles, consult with diabetes education nurse specialist
DM & Hypertension interventions - ansTreat to goal of SBP < 140.
Best= systolic <130 and diastolic <80
1st try life style medications, then 2nd try ACE/ARB to start, 3rd: add diuretic.
monitor BP at home and every HCP visit, monitor electrolytes, BUN, SrCr, and GFR
DM & Dyslipidemia interventions - anslifestyle modification, decrease saturated fat and
cholesterol in the diet, meds=statin therapy preventative, CVD risk and Aspirin therapy
(antiplatlet), get lipid panel drawn every 6 months
, Medical-Surgical Nursing Final.
A Comprehensive Exam Study Guide
With 100% Certified Answers by Experts.
Latest Updated Guide 2025/2026.
lipid panel targets for diabetes - ansLDL <100mg/dl; if have CVD LDL <70 (L you want
low)
HDL > 40 mg/dl in men, >50mg/dl in women (H you want high)
Triglycerides: <150 mg/dl
DM & Cardiovascular disease interventions - ansdiabetes pt's have a high risk of CVD d/t FH
and lifestyle. start with ACE/ARB, statin therapy, aspirin therapy, ... if they had a prior MI:
use a beta blocker; smoking cessation, get a yearly EKG
DM & Nephropathy interventions - ansprevention: glucose control
-optimize BP control
-1st primary prevention: ACE/ARB
-monitor urine micro albumin yearly...
monitor BUN/SrCr, GFR <60 = CKD
DM & Retinopathy interventions - ansprevention: glucose control
-comprehensive eye exam initially, then yearly eye exam.. in history, ask them when last eye
exam was.
Complications include: macular edema, retinal hemorrhage, retinopathy, blindness
DM & Neuropathy interventions - ansprevention: glucose control
monofilament testing every 6 months-yearly
teach them foot care, smoking cessation, they have high risk of PVD, meds to help with pain
(neurotic), test the ankle brachial index, podiatry as needed
neuropathy - ansis in the early stages of dm, usually type 2. pt's complain of numbers and
tingling.
footcare for diabetes - ansInspect feet daily. use mild soap and warm water. pat gently
including in between the toes when drying feet. perform nail care after a bath/shower, use
cotton or lamb's wool to separate overlapping toes, use a powder with cornstarch if feet get
sweaty, wear socks made of wool or lamb, wear shoes that fit correctly and are leather and
wear slippers with soles.. ALWAYS wear shoes!! no flip flops bc risk of injury and infection
other things to remember for footcare - ansshake out shoes before putting on to prevent injury
know the hospital protocol for nail care. some allow clippers to trim straight across and file
edge with emery board/nail file, some only allow nail files straight across.
foot care: "DO NOT..."'s - ansDO NOT: use commerical remedies for removing calluses or
corns, don't wear open-toe, open-heal shoes, don't wear plastic shoes for feet protection, don't
go barefoot, don't use heating pads or hot water bottles, don't stand or sit for prolonged
periods of time or cross legs
when medication therapy is initiated - ansif not able to meet the treatment goals of: HbA1c <
7.0 %, pre-meal BS are 80-130 mg/dl
peak after meal BS are <180 mg/dl
who takes oral diabetes medications - ansonly type 2 diabetics
insulin - ansinitiated if not meet tmt goals. there are 4 types: rapid acting, short acting,
intermediate acting, and long acting
A Comprehensive Exam Study Guide
With 100% Certified Answers by Experts.
Latest Updated Guide 2025/2026.
lispro insulin (humulog) - ansrapid acting insulin
onset of lispro insulin (humolog) - ansunder 15 minutes
peak of lispro insulin (humulog) - ans30 min to 1.5 hours
when to administer lispro insulin (humulog) - ans0-15 minutes prior to a meal
regular insulin (Humulin R, Novolin R) - ansshort acting insulin
onset of regular insulin (humulin R, Novolin R) - ans30 min to 60 minutes
peak of regular insulin (humulin R, Novolin R) - ans2 to 3 hours
when to administer regular insulin (humulin R, Novolin R) - ans30 minutes before a meal
lente insulin (humulin L) - ansintermediate acting insulin
onset of lente insulin - ans1 to 2 hours
when to administer lente insulin - ansdoes not need to be with a meal
peak of lente insulin - ans4 to 12 hours
insulin glargine - anslong acting insulin
precautions with insulin glargine (lantus) - ansinsulin glargine cannot be mixed with other
insulins!!, the action may be affected in an unpredictable manner.
onset of insulin glargine - ans1-1.5 hours
peak of insulin glargine - anshas no peak...lasts 24 hr
storage for insulin - ansinsulin vials should be stored in a refrigerator or they can be kept at
room temperature for up to 28 days. cartridges and pens should be stored at room temperature
and used within 28 days..
glucagon - ansa drug used to treat hypoglycemia. raises blood glucose levels
side effects of glucagon - ansn/v, hypotension, hypersensitivity, & hypokalemia
administration of glucagon - anscan be given SQ, IM, or IV. then as soon as the patient is
awake, give the patient some carbohydrate snack
mixing insulin - answhenever mixing insulin, the short acting (regular/humilin R) insulin is
drawn up first in order to prevent contamination. short acting is clear insulin and intermediate
acting (humilin L/lente) is cloudy, so it is drawn up clear then cloudy. insulin glargine cannot
be mixed with any kind of insulin.
metformin - ansthe most common oral hypoglycemic medication for pre diabetic patients and
non insulin dependent type 2 diabetes. is not used to treat type 1.
administration of metformin - anstaken each day. administer WITH food in order to prevent
GI upset. also take vitamin B12 and folic acid supplements
side effects of metformin - ansGI effects including anorexia, n/v, HA, abdominal gas/pain,
metallic taste, hypoglycemia,
LACTIC ACIDOSIS!! (unexplained muscle aches, fatigue, lethargy and hyperventilation)
*ok for pregnancy
precautions taking metformin - ansneeds to be stopped 48 hours before any type of
radiographic test with iodinated contrast dye and can't be resumed until 48 hours after
because this can cause lactic acidosis or ARF. watch renal function when taking metformin.
,Medical-Surgical Nursing Final.
A Comprehensive Exam Study Guide
With 100% Certified Answers by Experts.
Latest Updated Guide 2025/2026.
when to d/c metformin - ansimmediately if unexplained hypoxemia, dehydration, or signs of
lactic acidosis
what foods increase risk of hypoglycemia with oral anti diabetic drugs - anscelery, coriander,
dandelion root, garlic, ginseng
Diabetes mellitus - ansis a systemic, chronic, and progressive metabolic disease that requires
lifelong lifestyle modification. people with DM have the inability to metabolize
carbohydrates, proteins, and fats
Type 1 DM - anscan be genetic or autoimmune. involves the destruction of pancreatic beta
cells. has no or minimal insulin production.
aka Juvenile onset/ IDDM
Type 2 DM - anscan be genetic and environmental. either d/t desensitization (limited
response by beta cells) or insulin resistance (liver and peripheral tissues).
aka Adult onset/ NDDM
Type 1: age of onset, symptoms, insulin production, BMI, and insulin mgt - ansAge: <30 but
can occur at any age.
S/sx: abrupt onset, weight loss
Insulin production: None, no prevention.
BMI: usually non-obese
Insulin: dependent
Type 2: age of onset, symptoms, insulin production, BMI, and insulin mgt - ansAge: peak at
50 yo
S/sx: slow onset, fatigue
Insulin production: low, normal, or high. Preventable.
BMI: 60-80% of type 2 pts are obese
Insulin: 20-30% require
diabetic ketoacidosis - ansa complication of diabetes.. is a lack of insulin and ketosis.
more common in Type 1
hyperglycemia-hyperosmolar state - ansa complication of diabetes... is an insulin deficiency
and profound dehydration
hypoglycemia - ansa complication of diabetes... is too little insulin, too little glucose
s/sx of diabetes - ans3 p's (polyuria, polydipsia, polyphagia), unintended weight loss, fatigue
& weakness, irritability & mood changes, blurred vision, slow healing sores, acanthuses
nigricans, HTN, hyperlipidemia, liver impairment, frequent infections
complications of DM - ansretinopathy, nephropathy, neuropathy, CAD/CVD risk of stroke,
PVD
acanthosis nigricans - ansskin changes with DM2. skin folds around neck and armpits
HBA1C pre diabetes - ans5.7-6.4 %
HBA1C diabetes - ans> 6.5 %
goal is to be below 7 % for diabetics.
Fasting plasma glucose (FPG) - ans> 126 mg/dl
,Medical-Surgical Nursing Final.
A Comprehensive Exam Study Guide
With 100% Certified Answers by Experts.
Latest Updated Guide 2025/2026.
would be 8+ hours fasting, taken in the morning
Normal FPG for non diabetics - ans< 90
Oral Glucose Tolerance Test (OGTT) - ans> 200 mg/dl after 2 hours
-have patient drink several surgery drinks and take the BG and see how its tolerated?
**check ATI
Random serum glucose - ans> 200 mg/dl
CBC - ansinfection, anemia
CMP - anselectrolytes, liver, and renal function
Lipid panel - ansto show CVD risk
urine micro albumin - ansto show protein in the urine, indicates renal failure
other labs for DM 1 - ansantigens & antibodies for DM 1
Interventions for Pre-diabetics - ansgoal is for HBA1c to be < 6
-lifestyle modifications: weight loss of 7 % of body weight, exercise 150 min/week
-meformin therapy IF BMI > 35
-might have blood glucose monitoring
Interventions for Type 1 Diabetics - ansGoal is for HBA1C to be < 7
-lifestyle modification
-insulin therapy is LIFELONG
-basal insulin (short acting-sliding scale and intermediate acting)
-blood glucose monitoring
Interventions for Type 2 Diabetics - ansGoal is for HBA1C to be < 7
-lifestyle modifications
-try oral hypoglycemic agent 1st
-Insulin is possible tmt
-blood glucose monitoring
Nutritional interventions for diabetes - anspts should have medical nutrition therapy initially
after dx every 3 months. monitor eating patterns, carb counting/quality, dietary fat & protein,
supplements, decrease alcohol and sodium, increase fiber, consult with nutritionist.
GOAL = GLYCEMIC CONTROL (dec. HbA1C)
Education for diabetes patients - ansself management, medications, physical activity,
nutrition, hypoglycemia, blood sugar testing, follow up appts/HCP, immunizations: flu,
pneumonia, shingles, consult with diabetes education nurse specialist
DM & Hypertension interventions - ansTreat to goal of SBP < 140.
Best= systolic <130 and diastolic <80
1st try life style medications, then 2nd try ACE/ARB to start, 3rd: add diuretic.
monitor BP at home and every HCP visit, monitor electrolytes, BUN, SrCr, and GFR
DM & Dyslipidemia interventions - anslifestyle modification, decrease saturated fat and
cholesterol in the diet, meds=statin therapy preventative, CVD risk and Aspirin therapy
(antiplatlet), get lipid panel drawn every 6 months
, Medical-Surgical Nursing Final.
A Comprehensive Exam Study Guide
With 100% Certified Answers by Experts.
Latest Updated Guide 2025/2026.
lipid panel targets for diabetes - ansLDL <100mg/dl; if have CVD LDL <70 (L you want
low)
HDL > 40 mg/dl in men, >50mg/dl in women (H you want high)
Triglycerides: <150 mg/dl
DM & Cardiovascular disease interventions - ansdiabetes pt's have a high risk of CVD d/t FH
and lifestyle. start with ACE/ARB, statin therapy, aspirin therapy, ... if they had a prior MI:
use a beta blocker; smoking cessation, get a yearly EKG
DM & Nephropathy interventions - ansprevention: glucose control
-optimize BP control
-1st primary prevention: ACE/ARB
-monitor urine micro albumin yearly...
monitor BUN/SrCr, GFR <60 = CKD
DM & Retinopathy interventions - ansprevention: glucose control
-comprehensive eye exam initially, then yearly eye exam.. in history, ask them when last eye
exam was.
Complications include: macular edema, retinal hemorrhage, retinopathy, blindness
DM & Neuropathy interventions - ansprevention: glucose control
monofilament testing every 6 months-yearly
teach them foot care, smoking cessation, they have high risk of PVD, meds to help with pain
(neurotic), test the ankle brachial index, podiatry as needed
neuropathy - ansis in the early stages of dm, usually type 2. pt's complain of numbers and
tingling.
footcare for diabetes - ansInspect feet daily. use mild soap and warm water. pat gently
including in between the toes when drying feet. perform nail care after a bath/shower, use
cotton or lamb's wool to separate overlapping toes, use a powder with cornstarch if feet get
sweaty, wear socks made of wool or lamb, wear shoes that fit correctly and are leather and
wear slippers with soles.. ALWAYS wear shoes!! no flip flops bc risk of injury and infection
other things to remember for footcare - ansshake out shoes before putting on to prevent injury
know the hospital protocol for nail care. some allow clippers to trim straight across and file
edge with emery board/nail file, some only allow nail files straight across.
foot care: "DO NOT..."'s - ansDO NOT: use commerical remedies for removing calluses or
corns, don't wear open-toe, open-heal shoes, don't wear plastic shoes for feet protection, don't
go barefoot, don't use heating pads or hot water bottles, don't stand or sit for prolonged
periods of time or cross legs
when medication therapy is initiated - ansif not able to meet the treatment goals of: HbA1c <
7.0 %, pre-meal BS are 80-130 mg/dl
peak after meal BS are <180 mg/dl
who takes oral diabetes medications - ansonly type 2 diabetics
insulin - ansinitiated if not meet tmt goals. there are 4 types: rapid acting, short acting,
intermediate acting, and long acting
