NURS 354 LATEST 2026 STUDY GUIDE QUESTIONS AND
ANSWERS GRADED A+
✔✔indications for short acting insulin - ✔✔given 15 minutes before meals to prevent
hyperglycemia
(can be given in combination with longer-acting insulin)
✔✔intermediate acting insulin - ✔✔NPH
ONSET: 1-1.5 hr
PEAK: 4-12 hr
DURATION: up to 24 hr
*eat a snack at time of peak and onset
✔✔long acting insulin - ✔✔glargine detemir
ONSET: 3-6 hr
PEAK: continuous
DURATION: 24 hr
✔✔indications for long acting insulin - ✔✔used for basal dose
given once a day
✔✔rapid & short acting insulin - ✔✔expected to cover the increase in glucose levels
after meals, immediately after injection is given
✔✔intermediate acting insulin outcome - ✔✔expected to cover subsequent meals
✔✔long acting insulin outcome - ✔✔provide a relatively constant level of insulin
✔✔insulin waning - ✔✔progressive rise in blood glucose from bedtime to morning
treated:
- increasing the evening dose of intermediate or long acting insulin
✔✔dawn phenomenon - ✔✔relatively normal blood glucose until early morning hours
treated:
- changing time of insulin injection to bedtime
, ✔✔somogyi effect - ✔✔normal or elevated blood glucose at bedtime, early morning
hypoglycemia, and subsequent increased blood glucose
treated:
- decrease even insulin dose
✔✔glyburide (DiaBeta) - ✔✔ACTION: lowers blood glucose by increasing insulin
secretion
USE: in combination with diet to lower blood glucose in T2DM patients
- start with a low dosage and gradually increase until fasting glucose is 110 or less
ADVERSE: hypoglycemia
CONTRAINDICATION: severe renal or hepatic impairment, pregnancy
NURSING: alcohol decreases effects, take 30 minutes before meals
- trauma, infection, or increased stress may warrant dosage change
✔✔metformin (Glucophage) - ✔✔ACTION: reduces glucose production in the liver
USE: alone or in combination with insulin for T2DM
ADVERSE: lactic acidosis, N/V, dizziness
CONTRAINDICATION: fever, severe infection, trauma, pregnancy
NURSING: take with meals, stop 48 hours before iodine contrast
**BBW: not for patients over 80 years old due to risk of lactic acidosis
✔✔rosiglitizone (Avandia) - ✔✔ACTION: stimulates receptors on muscle, fat, and liver
cells to increase the effectiveness of circulating insulin; decreases insulin resistance
USE: monotherapy with diet and exercise; combination with insulin or metformin
ADVERSE: liver injury, diarrhea, sinusitis, upper respiratory infection, CHF, MI
NURSING: take with meals, if you miss a dose you CAN double the next dose
**BBW: risk of CHF (assess for weight gain, dyspnea, edema)
✔✔arcarbose (Precose) - ✔✔ACTION: delays digestion of carbs to diminish an increase
in blood glucose after meals
USE: in combination with insulin
ANSWERS GRADED A+
✔✔indications for short acting insulin - ✔✔given 15 minutes before meals to prevent
hyperglycemia
(can be given in combination with longer-acting insulin)
✔✔intermediate acting insulin - ✔✔NPH
ONSET: 1-1.5 hr
PEAK: 4-12 hr
DURATION: up to 24 hr
*eat a snack at time of peak and onset
✔✔long acting insulin - ✔✔glargine detemir
ONSET: 3-6 hr
PEAK: continuous
DURATION: 24 hr
✔✔indications for long acting insulin - ✔✔used for basal dose
given once a day
✔✔rapid & short acting insulin - ✔✔expected to cover the increase in glucose levels
after meals, immediately after injection is given
✔✔intermediate acting insulin outcome - ✔✔expected to cover subsequent meals
✔✔long acting insulin outcome - ✔✔provide a relatively constant level of insulin
✔✔insulin waning - ✔✔progressive rise in blood glucose from bedtime to morning
treated:
- increasing the evening dose of intermediate or long acting insulin
✔✔dawn phenomenon - ✔✔relatively normal blood glucose until early morning hours
treated:
- changing time of insulin injection to bedtime
, ✔✔somogyi effect - ✔✔normal or elevated blood glucose at bedtime, early morning
hypoglycemia, and subsequent increased blood glucose
treated:
- decrease even insulin dose
✔✔glyburide (DiaBeta) - ✔✔ACTION: lowers blood glucose by increasing insulin
secretion
USE: in combination with diet to lower blood glucose in T2DM patients
- start with a low dosage and gradually increase until fasting glucose is 110 or less
ADVERSE: hypoglycemia
CONTRAINDICATION: severe renal or hepatic impairment, pregnancy
NURSING: alcohol decreases effects, take 30 minutes before meals
- trauma, infection, or increased stress may warrant dosage change
✔✔metformin (Glucophage) - ✔✔ACTION: reduces glucose production in the liver
USE: alone or in combination with insulin for T2DM
ADVERSE: lactic acidosis, N/V, dizziness
CONTRAINDICATION: fever, severe infection, trauma, pregnancy
NURSING: take with meals, stop 48 hours before iodine contrast
**BBW: not for patients over 80 years old due to risk of lactic acidosis
✔✔rosiglitizone (Avandia) - ✔✔ACTION: stimulates receptors on muscle, fat, and liver
cells to increase the effectiveness of circulating insulin; decreases insulin resistance
USE: monotherapy with diet and exercise; combination with insulin or metformin
ADVERSE: liver injury, diarrhea, sinusitis, upper respiratory infection, CHF, MI
NURSING: take with meals, if you miss a dose you CAN double the next dose
**BBW: risk of CHF (assess for weight gain, dyspnea, edema)
✔✔arcarbose (Precose) - ✔✔ACTION: delays digestion of carbs to diminish an increase
in blood glucose after meals
USE: in combination with insulin
