Oral Diabetic Drugs
A newly diagnosed patient with type 2 diabetes has no renal impairment and is overweight. Which oral medication should the nurse expect to be prescribed FIRST?
A. Glyburide
B. Sitagliptin
C. Metformin
D. Pioglitazone
C. Metformin
Metformin is the first-line drug for type 2 diabetes.
It:
Decreases hepatic glucose production
Improves insulin sensitivity
Does not cause hypoglycemia when used alone
Often supports weight neutrality or loss
A patient with uncontrolled diabetes reports polyuria, polydipsia, and fatigue.
What pathophysiologic process BEST explains these symptoms?
A. Increased insulin sensitivity
B. Osmotic diuresis from excess glucose in the blood
C. Decreased counter-regulatory hormone release
D. Increased cellular glucose uptake
B. Osmotic diuresis from excess glucose in the blood
Elevated blood glucose exceeds renal threshold → glucose spills into urine → water follows → dehydration, thirst, and frequent urination.
A nurse administers insulin aspart (NovoLog) to a patient. The meal tray is delayed.
How soon is the patient at highest risk for hypoglycemia?
A. 30–60 minutes
B. 1–3 hours
C. 4–6 hours
D. 8–12 hours
B. 1-3 hours
NovoLog is fast-acting insulin.
Onset: ~10–15 minutes
Peak: 1–3 hours ⬅highest hypoglycemia risk
If food is not available during the peak, blood glucose can drop rapidly.
A nurse assesses a client who has flat affect, alogia, and avolition.
These findings are best classified as:
A. Positive symptoms
B. Cognitive symptoms
C. Affective symptoms
D. Negative symptoms
D. Negative symptoms
Negative symptoms represent the absence of normal behaviors or emotions and are harder to treat.
Which findings are considered positive symptoms of schizophrenia?
(Select all that apply)
A. Hallucinations
B. Delusions
C. Flat affect
D. Disorganized speech
E. Avolition
A, B, D
Positive = added behaviors or experiences not normally present.
A patient taking metformin is scheduled for a CT scan with IV contrast.
What is the nurse’s PRIORITY action?
A. Administer metformin after the scan
B. Hold metformin before and after the procedure
C. Increase fluid intake only
D. Monitor blood glucose every 4 hours
B. Hold metformin before and after the procedure
Metformin must be held with contrast dye due to risk of lactic acidosis, especially if renal function declines.
It is typically held the day of and 48 hours after, until kidney function is reassessed.
Which statement BEST describes the pathophysiology of type 2 diabetes mellitus?
A. Autoimmune destruction of beta cells
B. Absolute insulin deficiency
C. Insulin resistance with progressive beta-cell dysfunction
D. Lack of counter-regulatory hormones
C. Insulin resistance with progressive beta-cell dysfunction
Type 2 diabetes involves decreased insulin sensitivity and a gradual decline in insulin production.
A patient just received lispro (Humalog). The nurse notices the patient’s meal tray has not arrived.
What is the nurse’s PRIORITY action?
A. Monitor blood glucose in 2 hours
B. Administer IV dextrose
C. Obtain a rapid source of carbohydrates immediately
D. Hold the next insulin dose
C. Obtain a rapid source of carbohydrates immediately
Fast-acting insulin begins working within minutes.
The priority is preventing hypoglycemia, not waiting to treat it.
Oral carbohydrates (juice, glucose tabs) are first-line if the patient is conscious.
Which symptom MUST be present for a diagnosis of schizophrenia?
A. Catatonia
B. Negative symptoms
C. Delusions, hallucinations, or disorganized speech
D. Cognitive impairment
C. Delusions, hallucinations, or disorganized speech
DSM-5 requires at least one of the three core psychotic symptoms.
First-generation antipsychotics primarily improve which symptoms?
A. Negative
B. Cognitive
C. Positive
D. Affective
C. Positive
They block dopamine (D2) → reduce hallucinations and delusions.
Which oral diabetic medication class is MOST likely to cause hypoglycemia if the patient skips a meal?
A. Alpha-glucosidase inhibitors
B. DPP-4 inhibitors
C. Sulfonylureas
D. SGLT-2 inhibitors
C. Sulfonylureas
Sulfonylureas stimulate insulin release regardless of glucose level.
If food intake is missed, insulin release continues → hypoglycemia risk increases.
Chronic hyperglycemia causes damage to blood vessels over time.
Which complication is MOST directly related to this mechanism?
A. Hypoglycemia
B. Neuropathy
C. Acute pancreatitis
D. Electrolyte imbalance
B. Neuropathy
Persistent high glucose damages small blood vessels and nerves, leading to neuropathy, retinopathy, and nephropathy.
After initiating insulin therapy for severe hyperglycemia, which lab value should the nurse monitor most closely?
A. Sodium
B. Calcium
C. Potassium
D. Magnesium
C. Potassium
Insulin drives potassium into cells, which can cause hypokalemia.
This can lead to cardiac dysrhythmias, making potassium monitoring critical.
A client with schizophrenia reports hearing voices telling him to hurt his roommate.
What is the nurse’s priority action?
A. Encourage journaling
B. Ask the client to ignore the voices
C. Assess intent and increase supervision
D. Teach reality testing
C. Assess intent and increase supervision
Command hallucinations are a medical and safety emergency → protect patient and others first.
A client taking haloperidol develops muscle rigidity, tremors, and drooling.
These symptoms indicate:
A. Neuroleptic malignant syndrome
B. Tardive dyskinesia
C. Extrapyramidal symptoms (EPS)
D. Anticholinergic toxicity
C. Extrapyramidal symptoms (EPS)
D2 blockade in motor pathways → EPS.
A patient with type 2 diabetes and heart failure is prescribed a new oral antidiabetic medication. Which drug should the nurse question?
A. Sitagliptin
B. Metformin
C. Acarbose
D. Pioglitazone
D. Pioglitazone
Thiazolidinediones (pioglitazone):
Cause fluid retention and weight gain
Can worsen heart failure
Are contraindicated in moderate to severe HF
A patient with diabetes develops ketosis.
Which metabolic change leads to ketone production?
A. Increased glucose utilization
B. Decreased insulin sensitivity
C. Shift to fat metabolism for energy
D. Increased protein synthesis
C. Shift to fat metabolism for energy
Without enough insulin, cells can’t use glucose → body breaks down fat → ketone formation.
A nurse is preparing to administer Regular insulin and NPH insulin in the same syringe.
Which actions are correct when drawing up these insulins?
(Select all that apply)
A. Inject air into the NPH vial first
B. Inject air into the Regular insulin vial second
C. Withdraw Regular insulin before NPH insulin
D. Withdraw NPH insulin before Regular insulin
E. Roll the NPH vial gently before drawing it up
F. Shake the NPH vial to mix the insulin
A, B, C, E
A. Inject air into the NPH vial first
Prevents contamination of clear insulin with cloudy insulin.
B. Inject air into the Regular insulin vial second
Air is injected into both vials before withdrawing insulin.
C. Withdraw Regular insulin before NPH insulin
Clear → Cloudy prevents cloudy insulin from contaminating clear insulin.
D. Withdraw NPH insulin before Regular insulin
This would contaminate the clear insulin vial.
E. Roll the NPH vial gently
NPH is a suspension and must be mixed gently.
F. Shake the NPH vial
Shaking creates bubbles and alters dose accuracy.
A client states, “Martian invaders are coming to destroy Earth.”
Which response is MOST therapeutic?
A. “That isn’t real.”
B. “Why do you believe that?”
C. “That sounds frightening. Tell me how you’re feeling.”
D. “I don’t believe that.”
C. “That sounds frightening. Tell me how you’re feeling.”
Do not argue or reinforce delusions. Focus on feelings, not content.
Which assessment finding requires immediate action in a client taking antipsychotics?
A. Weight gain
B. Constipation
C. High fever and muscle rigidity
D. Dry mouth
C. High fever and muscle rigidity
This indicates Neuroleptic Malignant Syndrome (NMS) → medical emergency.
Which oral diabetic medication should be taken with the first bite of a meal to be effective?
A. Metformin
B. Alpha-glucosidase inhibitors
C. Thiazolidinediones
D. SGLT-2 inhibitors
B. Alpha-glucosidase inhibitors
Alpha-glucosidase inhibitors work in the GI tract to delay carbohydrate absorption.
A nurse is assessing two patients: one with diabetic ketoacidosis (DKA) and one with hyperglycemic hyperosmolar syndrome (HHS).
Which findings are MOST likely associated with DKA?
(Select all that apply)
A. Fruity (acetone) breath
B. Severe hyperglycemia (>600 mg/dL)
C. Kussmaul respirations
D. Presence of ketones
E. Profound dehydration without acidosis
F. Metabolic acidosis
A, C, D, F
A. Fruity breath
Caused by acetone, a ketone byproduct → DKA hallmark
B. Severe hyperglycemia (>600 mg/dL)
More typical of HHS, not DKA
C. Kussmaul respirations
Deep, rapid breathing to compensate for metabolic acidosis
D. Presence of ketones
DKA = fat breakdown → ketones
E. Profound dehydration without acidosis
Classic for HHS, not DKA
F. Metabolic acidosis
Core defining feature of DKA
Which type of insulin is contraindicated in patients with asthma or COPD?
A. Insulin glargine
B. Regular insulin
C. NPH insulin
D. Inhaled insulin
D. Inhaled insulin
Inhaled insulin is absorbed through the lungs and can cause bronchospasm and decreased pulmonary function.
It is contraindicated in patients with asthma, COPD, or a history of lung disease.
A client hears voices throughout the day. Which strategy BEST helps reduce hallucinations?
A. Sitting alone in a quiet room
B. Discussing hallucinations in detail
C. Listening to music and singing along
D. Avoiding stimulation
C. Listening to music and singing along
Competing auditory input helps drown out voices.
Which lab value is MOST important to monitor in a client taking clozapine?
A. Sodium
B. Potassium
C. Liver enzymes
D. Absolute neutrophil count (ANC)
D. Absolute neutrophil count (ANC)
Clozapine can cause severe neutropenia → infection risk.