Medical Surgical Nursing Final Exam Questions and Answers
lispro insulin (humulog)
Answer: rapid acting insulin
onset of lispro insulin (humolog)
Answer: under 15 minutes
peak of lispro insulin (humulog)
Answer: 30 min to 1.5 hours
when to administer lispro insulin (humulog)
Answer: 0-15 minutes prior to a meal
regular insulin (Humulin R, Novolin R)
Answer: short acting insulin
onset of regular insulin (humulin R, Novolin R)
Answer: 30 min to 60 minutes
peak of regular insulin (humulin R, Novolin R)
Answer: 2 to 3 hours
when to administer regular insulin (humulin R, Novolin R)
Answer: 30 minutes before a meal
lente insulin (humulin L)
Answer: intermediate acting insulin
onset of lente insulin
Answer: 1 to 2 hours
when to administer lente insulin
Answer: does not need to be with a meal
peak of lente insulin
Answer: 4 to 12 hours
insulin glargine
Answer: long acting insulin
precautions with insulin glargine (lantus)
Answer: insulin glargine cannot be mixed with other insulins!!, the action may be affected in an
unpredictable manner.
onset of insulin glargine
Answer: 1-1.5 hours
,peak of insulin glargine
Answer: has no peak...lasts 24 hr
storage for insulin
Answer: insulin 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
Answer: a drug used to treat hypoglycemia. raises blood glucose levels
side effects of glucagon
Answer: n/v, hypotension, hypersensitivity, & hypokalemia
administration of glucagon
Answer: can be given SQ, IM, or IV. then as soon as the patient is awake, give the patient some
carbohydrate snack
mixing insulin
Answer: whenever 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
Answer: the 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
Answer: taken each day. administer WITH food in order to prevent GI upset. also take vitamin B12 and
folic acid supplements
side effects of metformin
Answer: GI 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
Answer: needs 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.
when to d/c metformin
Answer: immediately if unexplained hypoxemia, dehydration, or signs of lactic acidosis
what foods increase risk of hypoglycemia with oral anti diabetic drugs
Answer: celery, coriander, dandelion root, garlic, ginseng
Diabetes mellitus
,Answer: is 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
Answer: can be genetic or autoimmune. involves the destruction of pancreatic beta cells. has no or
minimal insulin production.
aka Juvenile onset/ IDDM
Type 2 DM
Answer: can 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
Answer: Age: <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
Answer: Age: 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
Answer: a complication of diabetes.. is a lack of insulin and ketosis.
more common in Type 1
hyperglycemia-hyperosmolar state
Answer: a complication of diabetes... is an insulin deficiency and profound dehydration
hypoglycemia
Answer: a complication of diabetes... is too little insulin, too little glucose
s/sx of diabetes
Answer: 3 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
Answer: retinopathy, nephropathy, neuropathy, CAD/CVD risk of stroke, PVD
acanthosis nigricans
Answer: skin changes with DM2. skin folds around neck and armpits
, HBA1C pre diabetes
Answer: 5.7-6.4 %
HBA1C diabetes
Answer: > 6.5 %
goal is to be below 7 % for diabetics.
Fasting plasma glucose (FPG)
Answer: > 126 mg/dl
would be 8+ hours fasting, taken in the morning
Normal FPG for non diabetics
Answer: < 90
Oral Glucose Tolerance Test (OGTT)
Answer: > 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
Answer: > 200 mg/dl
CBC
Answer: infection, anemia
CMP
Answer: electrolytes, liver, and renal function
Lipid panel
Answer: to show CVD risk
urine micro albumin
Answer: to show protein in the urine, indicates renal failure
other labs for DM 1
Answer: antigens & antibodies for DM 1
Interventions for Pre-diabetics
Answer: goal 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
Answer: Goal is for HBA1C to be < 7
-lifestyle modification
-insulin therapy is LIFELONG
-basal insulin (short acting-sliding scale and intermediate acting)
lispro insulin (humulog)
Answer: rapid acting insulin
onset of lispro insulin (humolog)
Answer: under 15 minutes
peak of lispro insulin (humulog)
Answer: 30 min to 1.5 hours
when to administer lispro insulin (humulog)
Answer: 0-15 minutes prior to a meal
regular insulin (Humulin R, Novolin R)
Answer: short acting insulin
onset of regular insulin (humulin R, Novolin R)
Answer: 30 min to 60 minutes
peak of regular insulin (humulin R, Novolin R)
Answer: 2 to 3 hours
when to administer regular insulin (humulin R, Novolin R)
Answer: 30 minutes before a meal
lente insulin (humulin L)
Answer: intermediate acting insulin
onset of lente insulin
Answer: 1 to 2 hours
when to administer lente insulin
Answer: does not need to be with a meal
peak of lente insulin
Answer: 4 to 12 hours
insulin glargine
Answer: long acting insulin
precautions with insulin glargine (lantus)
Answer: insulin glargine cannot be mixed with other insulins!!, the action may be affected in an
unpredictable manner.
onset of insulin glargine
Answer: 1-1.5 hours
,peak of insulin glargine
Answer: has no peak...lasts 24 hr
storage for insulin
Answer: insulin 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
Answer: a drug used to treat hypoglycemia. raises blood glucose levels
side effects of glucagon
Answer: n/v, hypotension, hypersensitivity, & hypokalemia
administration of glucagon
Answer: can be given SQ, IM, or IV. then as soon as the patient is awake, give the patient some
carbohydrate snack
mixing insulin
Answer: whenever 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
Answer: the 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
Answer: taken each day. administer WITH food in order to prevent GI upset. also take vitamin B12 and
folic acid supplements
side effects of metformin
Answer: GI 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
Answer: needs 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.
when to d/c metformin
Answer: immediately if unexplained hypoxemia, dehydration, or signs of lactic acidosis
what foods increase risk of hypoglycemia with oral anti diabetic drugs
Answer: celery, coriander, dandelion root, garlic, ginseng
Diabetes mellitus
,Answer: is 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
Answer: can be genetic or autoimmune. involves the destruction of pancreatic beta cells. has no or
minimal insulin production.
aka Juvenile onset/ IDDM
Type 2 DM
Answer: can 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
Answer: Age: <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
Answer: Age: 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
Answer: a complication of diabetes.. is a lack of insulin and ketosis.
more common in Type 1
hyperglycemia-hyperosmolar state
Answer: a complication of diabetes... is an insulin deficiency and profound dehydration
hypoglycemia
Answer: a complication of diabetes... is too little insulin, too little glucose
s/sx of diabetes
Answer: 3 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
Answer: retinopathy, nephropathy, neuropathy, CAD/CVD risk of stroke, PVD
acanthosis nigricans
Answer: skin changes with DM2. skin folds around neck and armpits
, HBA1C pre diabetes
Answer: 5.7-6.4 %
HBA1C diabetes
Answer: > 6.5 %
goal is to be below 7 % for diabetics.
Fasting plasma glucose (FPG)
Answer: > 126 mg/dl
would be 8+ hours fasting, taken in the morning
Normal FPG for non diabetics
Answer: < 90
Oral Glucose Tolerance Test (OGTT)
Answer: > 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
Answer: > 200 mg/dl
CBC
Answer: infection, anemia
CMP
Answer: electrolytes, liver, and renal function
Lipid panel
Answer: to show CVD risk
urine micro albumin
Answer: to show protein in the urine, indicates renal failure
other labs for DM 1
Answer: antigens & antibodies for DM 1
Interventions for Pre-diabetics
Answer: goal 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
Answer: Goal is for HBA1C to be < 7
-lifestyle modification
-insulin therapy is LIFELONG
-basal insulin (short acting-sliding scale and intermediate acting)
