Insulin and Non-Insulin Injectable Diabetes Drugs

Every question here, with the answer

1. A client received insulin lispro, a rapid-acting insulin, at 0800. When is the client at greatest risk for hypoglycemia?

   1. 0815
   2. 2000
   3. 1400
   4. 0900 to 1000

   Answer: 0900 to 1000

   Rapid-acting insulin peaks 1–2 hours after injection, and hypoglycemia risk is highest when insulin is peaking, so 0900 to 1000. At 0815 it is only starting to work, and by 1400 its 2–4 hour duration is over.

2. A nurse on a busy unit wants to use a client's insulin pen for a second client whose own pen has not arrived from pharmacy. What is the correct action?

   1. Use the pen with a new needle.
   2. Do not use the pen for anyone except the client it was prescribed for.
   3. Use the pen only if both clients take the same insulin.
   4. Use the pen after wiping it with alcohol.

   Answer: Do not use the pen for anyone except the client it was prescribed for.

   Insulin pens are never used for more than one person, because blood can regurgitate into the cartridge and transmit blood-borne pathogens. A new needle or wiping the pen does not remove that risk.

3. A client on an IV insulin drip is ready to switch to subcutaneous insulin. What should the nurse do?

   1. Stop the drip and wait for the next meal to give insulin.
   2. Give the subcutaneous dose and continue the drip for 30–60 minutes.
   3. Give the subcutaneous dose and stop the drip at the same moment.
   4. Stop the drip, then give the subcutaneous dose an hour later.

   Answer: Give the subcutaneous dose and continue the drip for 30–60 minutes.

   The first subcutaneous dose is given before stopping the drip, and the drip continues 30–60 minutes after it to prevent rebound hyperglycemia. Stopping first leaves the client with no insulin coverage.

4. The nurse is teaching a client who is starting insulin injections at home. Which instructions are correct? Select all that apply.

   1. Keep 15 grams of carbohydrates on hand.
   2. Rotate injection sites.
   3. Store insulin in the freezer.
   4. Show family members how to give glucagon.
   5. Use any syringe available if you run out of insulin syringes.

   Answer: Keep 15 grams of carbohydrates on hand., Rotate injection sites., Show family members how to give glucagon.

   Rotating sites prevents fatty deposits, carrying 15 grams of carbohydrate treats hypoglycemia, and family should know how to give glucagon if the client cannot eat or is unconscious. Insulin is stored in a refrigerator at about 36–46°F, and only insulin syringes are used.

5. Which statements about types of insulin are accurate? Select all that apply.

   1. All insulins are cloudy and must be mixed before use.
   2. Insulin isophane NPH is cloudy.
   3. Insulin glargine is long-acting and has no peak.
   4. Human regular insulin is typically the insulin given intravenously.
   5. Rapid-acting insulin has a duration of up to 24 hours.

   Answer: Insulin isophane NPH is cloudy., Insulin glargine is long-acting and has no peak., Human regular insulin is typically the insulin given intravenously.

   Long-acting insulins such as glargine have no peak, NPH is the one cloudy insulin, and human regular insulin is typically the only insulin given IV. Rapid-acting insulin lasts 2–4 hours, and insulins are typically clear.

6. A client with type 2 diabetes is prescribed dulaglutide, a GLP-1 receptor agonist. Which finding in the history should the nurse report before the first dose?

   1. Body weight above the ideal range
   2. A1c of 7.5%
   3. History of medullary thyroid cancer
   4. Taking metformin

   Answer: History of medullary thyroid cancer

   The black box warning says GLP-1 receptor agonists should not be taken with a history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2. Excess weight and a raised A1c are reasons the drug may be used, and dulaglutide can be combined with biguanides.