NURS 5334 Exam 3 UPDATED ACTUAL
Exam Questions and CORRECT Answers
What drugs are used to treat gestational diabetes? - CORRECT ANSWER - Metformin abd
Insulin
What A1C value indicates diabetes mellitus? Pre-DM? - CORRECT ANSWER - 6.5% or
greater is considered diabetes o 5.7-6.4%pre-diabetes
What fasting and random values indicate DM? - CORRECT ANSWER - Fasting plasma
glucose—126 or greater is diabetes. Random (casual) plasma glucose—anything greater than
200 is diabetes
What are complications of insulin therapy? - CORRECT ANSWER - Hypoglycemia
Can develop lipohypertrophy. Accumulation of subcutaneous fat that occurs when it is injected
too frequently at the same site. Allergic reactions
Characterized by red and intensely itchy welts, breathing becomes difficult
If severe allergy develops:
Desensitization procedure (small doses to larger doses). Hypokalemia
Promotes the uptake of potassium cells and insulin activates a membrane-bound enzyme with
sodium potassium and ATPase that pumps potassium into the cells and sodium out
insulin drug interactions - CORRECT ANSWER - o Hypoglycemicagents
Can intensify the hypoglycemia included by insulin
Examples: sulfonylureas, glinides, alcohol o Usewithcautionwithhyperglycemicagents
Examples: thiazide and glucocorticoids and sympathomimetics
What effect do beta blockers have on insulin? - CORRECT ANSWER - delay awareness
of and response to hypoglycemia by masking the signs that are associated with stimulation of
sympathetic nervous system
,o Impairglycogenolysis
o Prevent the bodies counter-regulatory response
What are other therapeutic uses besides DM? - CORRECT ANSWER - Hyperkalemia o
Aids in diagnosis of GH deficiency o Diabeticketoacidosis
Insulin dosage must be coordinated with what? - CORRECT ANSWER - Carbohydrate
intake
What is B/P goal in diabetic? - CORRECT ANSWER - o To be controlled, within normal
120/80
What medication can be given to decrease risk of diabetic nephropathy? - CORRECT
ANSWER - ACE inhibitor or ARB
What role does exercise play in treatment of both type 1 and type 2 DM? - CORRECT
ANSWER - Exercise increases cellular responsiveness to insulin and increases glucose
tolerance o 150 minute per week of moderate intensity exercise is recommended
What are the 4 steps in the 4-step approach? - CORRECT ANSWER - Step1—diagnosis
Lifestyle changes plus metformin o Step2
Lifestyle changes plus metformin and a second drug (sulfonylurea, TZD or a DPP4 inhibitor, a
sodium glucose cotransporter or SGLT-2 inhibitor, a glucagon-like peptide 1, or a GLP-1
receptor agonist or basal insulin
Second drug choice made considering efficacy, the hypoglycemia risk of the patient, the patient
tolerability, and weight-related considerations (some help weight loss, some cause weight gain),
cost
o Step3
Three drug combination
Metformin
Plus 2 other drugs from step 2
,o Decidedbasedonadrugandpatientspecificconsiderations
o Step4
If 3 drug combination that includes basal insulin fails after 3-6 months, more
complex insulin regimen
Usually in combination with one or more non-insulin medications
When a patient is on insulin therapy what are the blood glucose goals before meals? At bedtime?
- CORRECT ANSWER - Beforemeals—70-130
o Bedtime—100-140
What is the A1C goal? When is goal below 7 not appropriate? - CORRECT ANSWER -
7%or below o Those with severe hypoglycemia risk, limited life expectancy ,advanced
microvascular or
macrovascular complications—not below 7
What are the short acting insulins? Intermediate? Long acting? - CORRECT ANSWER -
Shortduration:Rapidacting
Insulin lispro [Humalog]
Insulin aspart [NovoLog]
Insulin glulisine [Apidra] o Shortduration:Sloweracting
Regular insulin [Humulin R, Novolin R] o Intermediateduration
Neutral protamine Hagedorn (NPH) insulin
Insulin detemir [Levemir] o Longduration
Insulin glargine
When are short duration insulins used? - CORRECT ANSWER - Administered in
association with meals to control the post-prandial rise in blood glucose between meals and at
night
, When are intermediate insulins needed? - CORRECT ANSWER - Administer 2-3 times
daily to provide glycemic control between meals and during the
night
How long is duration of glargine? Levemir? Degludec? - CORRECT ANSWER -
Glargine—up to 24 hours o Levemir
Low dose (0.2 units/kg)—12 hours
High doses (0.4 units/kg)—20-24 hours
o Degludec—up to 42 hours
What are routes of administration? Which can be inhaled? - CORRECT ANSWER - SQ
injection IV infusion. Inhalation—Afrezza, meal time insulin
Typical insulin dosing for type 1? Type 2? - CORRECT ANSWER - Total doses may range
from 0.1 unit/kg body weight to more than 2.5 units/kg Type1
Initial doses typically range from 0.5-0.6 units/kg per day Type2
Initial doses range from 0.2-0.6 units/kg per day
Dosage increased or decreased according to carb intake, activity
What are the 3 dosing schedules? - CORRECT ANSWER - o Twice daily dosing o
Intensive basal/bolus strategy o Continued subcutaneous insulin
How does metformin work? - CORRECT ANSWER - o Inhibits glucose production in the
livero Reduces glucose absorption in the guto Sensitizes insulin receptors in target tissues (fat
and skeletal muscle) thus increase
glucose uptake and response to whatever insulin is available
Metformin What are side effects? BB warning? - CORRECT ANSWER - o GI effects—
diarrhea
o Lactic acidosis
Exam Questions and CORRECT Answers
What drugs are used to treat gestational diabetes? - CORRECT ANSWER - Metformin abd
Insulin
What A1C value indicates diabetes mellitus? Pre-DM? - CORRECT ANSWER - 6.5% or
greater is considered diabetes o 5.7-6.4%pre-diabetes
What fasting and random values indicate DM? - CORRECT ANSWER - Fasting plasma
glucose—126 or greater is diabetes. Random (casual) plasma glucose—anything greater than
200 is diabetes
What are complications of insulin therapy? - CORRECT ANSWER - Hypoglycemia
Can develop lipohypertrophy. Accumulation of subcutaneous fat that occurs when it is injected
too frequently at the same site. Allergic reactions
Characterized by red and intensely itchy welts, breathing becomes difficult
If severe allergy develops:
Desensitization procedure (small doses to larger doses). Hypokalemia
Promotes the uptake of potassium cells and insulin activates a membrane-bound enzyme with
sodium potassium and ATPase that pumps potassium into the cells and sodium out
insulin drug interactions - CORRECT ANSWER - o Hypoglycemicagents
Can intensify the hypoglycemia included by insulin
Examples: sulfonylureas, glinides, alcohol o Usewithcautionwithhyperglycemicagents
Examples: thiazide and glucocorticoids and sympathomimetics
What effect do beta blockers have on insulin? - CORRECT ANSWER - delay awareness
of and response to hypoglycemia by masking the signs that are associated with stimulation of
sympathetic nervous system
,o Impairglycogenolysis
o Prevent the bodies counter-regulatory response
What are other therapeutic uses besides DM? - CORRECT ANSWER - Hyperkalemia o
Aids in diagnosis of GH deficiency o Diabeticketoacidosis
Insulin dosage must be coordinated with what? - CORRECT ANSWER - Carbohydrate
intake
What is B/P goal in diabetic? - CORRECT ANSWER - o To be controlled, within normal
120/80
What medication can be given to decrease risk of diabetic nephropathy? - CORRECT
ANSWER - ACE inhibitor or ARB
What role does exercise play in treatment of both type 1 and type 2 DM? - CORRECT
ANSWER - Exercise increases cellular responsiveness to insulin and increases glucose
tolerance o 150 minute per week of moderate intensity exercise is recommended
What are the 4 steps in the 4-step approach? - CORRECT ANSWER - Step1—diagnosis
Lifestyle changes plus metformin o Step2
Lifestyle changes plus metformin and a second drug (sulfonylurea, TZD or a DPP4 inhibitor, a
sodium glucose cotransporter or SGLT-2 inhibitor, a glucagon-like peptide 1, or a GLP-1
receptor agonist or basal insulin
Second drug choice made considering efficacy, the hypoglycemia risk of the patient, the patient
tolerability, and weight-related considerations (some help weight loss, some cause weight gain),
cost
o Step3
Three drug combination
Metformin
Plus 2 other drugs from step 2
,o Decidedbasedonadrugandpatientspecificconsiderations
o Step4
If 3 drug combination that includes basal insulin fails after 3-6 months, more
complex insulin regimen
Usually in combination with one or more non-insulin medications
When a patient is on insulin therapy what are the blood glucose goals before meals? At bedtime?
- CORRECT ANSWER - Beforemeals—70-130
o Bedtime—100-140
What is the A1C goal? When is goal below 7 not appropriate? - CORRECT ANSWER -
7%or below o Those with severe hypoglycemia risk, limited life expectancy ,advanced
microvascular or
macrovascular complications—not below 7
What are the short acting insulins? Intermediate? Long acting? - CORRECT ANSWER -
Shortduration:Rapidacting
Insulin lispro [Humalog]
Insulin aspart [NovoLog]
Insulin glulisine [Apidra] o Shortduration:Sloweracting
Regular insulin [Humulin R, Novolin R] o Intermediateduration
Neutral protamine Hagedorn (NPH) insulin
Insulin detemir [Levemir] o Longduration
Insulin glargine
When are short duration insulins used? - CORRECT ANSWER - Administered in
association with meals to control the post-prandial rise in blood glucose between meals and at
night
, When are intermediate insulins needed? - CORRECT ANSWER - Administer 2-3 times
daily to provide glycemic control between meals and during the
night
How long is duration of glargine? Levemir? Degludec? - CORRECT ANSWER -
Glargine—up to 24 hours o Levemir
Low dose (0.2 units/kg)—12 hours
High doses (0.4 units/kg)—20-24 hours
o Degludec—up to 42 hours
What are routes of administration? Which can be inhaled? - CORRECT ANSWER - SQ
injection IV infusion. Inhalation—Afrezza, meal time insulin
Typical insulin dosing for type 1? Type 2? - CORRECT ANSWER - Total doses may range
from 0.1 unit/kg body weight to more than 2.5 units/kg Type1
Initial doses typically range from 0.5-0.6 units/kg per day Type2
Initial doses range from 0.2-0.6 units/kg per day
Dosage increased or decreased according to carb intake, activity
What are the 3 dosing schedules? - CORRECT ANSWER - o Twice daily dosing o
Intensive basal/bolus strategy o Continued subcutaneous insulin
How does metformin work? - CORRECT ANSWER - o Inhibits glucose production in the
livero Reduces glucose absorption in the guto Sensitizes insulin receptors in target tissues (fat
and skeletal muscle) thus increase
glucose uptake and response to whatever insulin is available
Metformin What are side effects? BB warning? - CORRECT ANSWER - o GI effects—
diarrhea
o Lactic acidosis
