PHARM- THE ENDOCRINE SYSTEM - CASE STUDY Q/A

The client will self- inject eight units of NPH insulin and four units of regular insulin each day before breakfast. As you show the client how to self-administer insulin, you should include which of the following instructions? ( Select all that apply)
a. draw the regular insulin into the syringe first, then the NPH insulin
b. Inject the insulin mixture into a large muscle
c. Discard any unused premixed syringes within 5 days
d. Use a 5-mL syringe when mixing two types of insulin
e. Use one syringe to reduce the number of injections
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The client will self- inject eight units of NPH insulin and four units of regular insulin each day before breakfast. As you show the client how to self-administer insulin, you should include which of the following instructions? ( Select all that apply)
a. draw the regular insulin into the syringe first, then the NPH insulin
b. Inject the insulin mixture into a large muscle
c. Discard any unused premixed syringes within 5 days
d. Use a 5-mL syringe when mixing two types of insulin
e. Use one syringe to reduce the number of injections
a. . draw the regular insulin into the syringe first, then the NPH insulin
e. Use one syringe to reduce the number of injections

( You should instruct the client to draw the regular insulin into the syringe first to prevent mixing NPH insulin into the vial of regular insulin. The client should inject insulin subq, not into a large muscle. the client may store premixed syringes for 1 to 2 weeks refrigerated and vertical with the needles pointing upward. The client should resuspend the insulin gently prior to injection and must always use an insulin syringe to prevent errors in dosing. the client may mix NPH insulin and regular insulin in the same syringe to reduce the number of injections. The client should not mix insulin glargine or insulin determir with any other insulin)
You instruct the client to watch for and report which of the following indications of an adverse reaction to insulin?
a. palpatation
b. weight gain
c. low urine output
d. constipation
a. palpation

(Insulin can cause hypokalemia. You should monitor potassium levels and instruct the client to watch for and report muscle weakness, nausea, palpitations, or parasthesias. Insulin can cause hypoglycemia, which causes tachycardia, palpitations, and diaphoresis. Insulin is unlikely to cause weight gain. Desmopressin, whose brand name is DDAVP, is an example of an endocrine-system drug that can cause fluid retention and weight gain. Insulin is unlikely to cause reduced urine output, although hyperglycemia can cause polyuria. Insulin is unlike to cause constipation. Repaglinide, is a meglitinide that can cause diarrhea.
As you continue to talk with the client about managing her diabetes with regular insulin ( Humulin R) , you should include which of the following instructions? Select all that apply.
a. self-inject chilled insulin
b. carry a carb snack
c. rotate injection site
d. wear a medical alert bracelet
e. expect to adjust the dosage during illness
b. carry a carbohydrates snack
c. rotate injection site
d. wear a medical alert bracelet
e. expect to adjust the dosage during illness

( Injectable insulin can cause lipohypertrophy, an accumulation of subq fat. Injecting room temp insulin and rotating injection sites help minimize this adverse effect. the client should carry a carb snack with her at all times in case of hypoglycemia. She should also wear a medical alert bracelet incase of hypoglycemia that causes a loss of consciousness, sot that health care professionals will know to administer glucose or glucagon parenterally. The client should anticipate insulin dosage adjustment during stress, illness, infection, or pregnancy.
You give the client five units of lispro insulin (Humalog) and 10 units of insulin glargine subq at 1400. Based on your instructions, the client should expect her blood glucose level to be at the lowest at which of the following times?
- 1500 p.m.

( Lispro is a rapid-acting insulin that has an onset of 15-30 minutes and peaks at 30 minutes to 2.5 hours. The client's glucose should be the lowest between 1430 and 1630. Lispro Insulin has a duration of 3 to 6 hours , so the client should continue to check her blood glucose and watch for indications of hypoglycemia, such as tremors, headache, and weakness. Insulin glargine has an onset of 70 minutes, does not have a peak and last up to 24 hours.
Two hours after self-administering regular insulin subq, the client contacts you at the provider's office to report that she is sweating, shaky, and has a rapid pulse, Which of the following action should you advice her to take? Select all that apply

a. drink 4 oz of orange juice
b. check her blood glucose level
c. take an oral hypoglycemic
d. measure her urine output
e. self- administer a long- acting insulin
a. drink 4 oz of orange juice
b. check her blood glucose level

( Sub q regular insulin peaks 1-5 hrs and cause hypoglycemia. The client knows to watch for indications of hypoglycemia, such as tachycardia, hunger, shakiness, and diaphoresis. At this point, she should check her blood glucose level and, if it low, consume glucose tablets, orange juice, sugar cubes, honey, corn syrup , or non-diet soda to treat hypoglycemia. She should retest in 15 to 20 minutes and repeat the carbs snack if she is still hypoglycemic. She should not take an oral hypoglycemic or a long- acting hypoglycemic for indications of hypoglycemia, because those options would worsen her hypoglycemic state. Regular insulin in unlikely to affect urine output
You are caring for a client who is taking exenatide (Byetta) to treat type 2 diabetes mellitus. The client reports severe abdominal pain. You suspect which of the following adverse reactions to this drug?
a. peptic ulcer disease
b. hyperkalemia
c. hyperglycemia
d. pancreatitis
- pancreatitis

(Exenatide, an incretin mimetic agent can cause acute pancreatitis. You instructed the client to watch for and report severe or persistent abdominal pain, sometimes, radiating to the back , may or may not be accompanies by vomiting) at beginning of therapy and with dose increases, so you should now inform the primary care provider and tell the client to stop taking the drug. Exenatide is unlikely to cause hyperkalemia, an effect much more likely with insulin. For client taking insulin, monitor potassium levels and instruct them to report muscle weakness or palpitations. Exenatide is more likely to cause hypoglycemia than hyperglycemia, so monitor blood glucose levels carefully and administer carbohydrates for hypoglycemia. Indications of hypoglycemia include: tachycardia, diaphoresis, shakiness, and weakness
You are caring for a client who takes acarbose (Precose) and a sulfonylurea to treat type 2 diabetes mellitus. Which of the following is an indication of an adverse reaction to this drug combination ?
a. polyruria
b. tremors
c. bradycardia
d. thirst
- tremors

( this drug combination can cause hypoglycemia. indication of hypoglycemic reaction include: hunger, tachycardia, shakiness, tremors, and diaphoresis. Polyuria and thirst are indication of hyperglycemia, not hypoglycemia. Tachycardia not bradycardia is an indication of hypoglycemia. Acarbose, with or without sulfonylurea therapy, in unlikely to cause bradycardia
Glipizide (Glucotrol)- sulfonylurea- oral antidiabetic drug therapeutic use:
type 2 diabetes
Glucagon (GlucaGen)- hyperglycemic drug, therapeutic use:
hypoglycemia ( due to insulin overdose)
Desmopressin (DDAVP)- antidiuretic hormone therapeutic use:
diabetes insipidus
radioactive iodine -131 (Iodotope) - antithyroid drug- therapeutic use:thyroid cancer; also treat hyperthyroidism from Grave's diseaseA client is about to start taking sustained release glipizide to treat type 2 diabetes mellitus. Which of the following instructions should you include when taking with the client about taking this drug?