NUR 2474 Final Exam 3 Review
Please review general tips from Quiz review document (test taking strategies, select all that
apply questions, etc.). The test will utilize Respondus browser and monitor (using webcam). No
notes or textbook allowed on the test. Calculator will be enabled in the browser
.
General tips for studying:
1. Memorize names of medication categories from the presentation
2. Memorize key drugs from categories above (there are many questions with specific drug
names)
3. Use generic names
4. When reviewing particular drugs note category, indications, common side effects, toxicity
signs (if applicable), reversal agents, mechanism of action (e.g. agonizing or
antagonizing which receptors)
5. Read question instructions (there will be ‘select all that apply’ questions)
Topics to review:
1. What to monitor in patients on insulin therapy, NPO status and insulin therapy
a. Blood glucose level: 70-110 is optimal. Above 110 is hyperglycemic and less than
70 is hypoglycemic.
b. If above a certain range, we may give insulin on a sliding scale.
c. If NPO and hypoglycemia, the nurse should prepare to administer IV D50 so the
patient does not have anything to eat or drink but is still able to get a sugar
glucose solution quickly to increase the blood glucose level. After this is done,
the BG level should be rechecked.
d. If you give insulin and the patient don’t want to eat it, is a big deal- hypoglycemia
e. If you have a patient who is NPO and they just received insulin and their blood
sugar drops below 70 that is a cause of concern.
2. Signs of hypoglycemia
a. S/S: BG level less than 70, mild shakiness, mental confusion, sweating,
palpitations, headache, lack of coordination, blurry vision, seizures, coma, cold,
pale, irritable, hungry. “Cold and Clammy needs candy”
b. Hypoglycemia rule of 15: check BG level, if less than 70- give 15 g carb or IV
D50 if unable to take PO carbs, wait 15 mins and recheck. Upon recheck, if still
, less than 70- give another 15 g carbs and wait 15 mins and recheck and call
HCP. If still under 70 after 3rd BG recheck, give IV D50 and call HCP as this
could mean something serious is occurring.
c. Good sources of 15 g carbs: 4 oz fruit juice, 1 cup milk, 1 tbsp honey, 1 tbsp
sugar, 6-8 pieces of candy, soda.
d. Once the blood sugar returns, give a complex carb like peanut butter crackers.
3. Memorize insulin names by categories (rapid, short, intermediate, long-acting, and
mixed)
a. Rapid Acting Insulin
i. Common examples: Aspart (NovoLog), Lispro (Humalog), Glulisine
(Apidra)
1. Onset: 5-15 minutes. Administer with meals. DO NOT administer
unless a meal is readily available.
2. Peak: 1-3 hours
3. Duration: 3-5 hours.
ii. Monitor for hypoglycemia, hypokalemia, lipodystrophy.
iii. Always have oral carbohydrate available.
iv. May be given as a short-term IV therapy with very close monitoring
b. Short Acting Insulin (Regular)
i. Common examples: Humulin R, Novolin R,
1. Onset: 30 minutes to 1 hour
2. Peak: 2-4 hours
3. Duration: 6-8 hours.
ii. Used for dosing patients with Sliding Scale
iii. Can be administered IVP or via continuous infusion.
iv. Monitor for hypoglycemia, hypokalemia, lipodystrophy.
v. Always have oral carbohydrate available.
c. Intermediate Acting Insulin
i. Common examples: Isophane suspension (NPH, Humulin N, Novolin N)
1. Onset: 1-1.5 hours,
2. Peak: 6-12 hours
3. Duration: 18-24 hours.
ii. Cloudy suspension. Can mix with Regular or Rapid Acting Insulin, draw
up clear
1. (Regular or Rapid Acting) then cloudy (NPH), “Clear to Cloudy.”
iii. Monitor for hypoglycemia, hypokalemia, lipodystrophy.
iv. Always have oral carbohydrate available.
d. Long-Acting Insulin
i. Common examples: Glargine (Lantus), Levemir, Detemir
ii. For Long lasting remember: Levemir/Detemir “last all year”, Glargine is
Large lasting or Lantus is like a lantern that burns all night
1. Onset: 2-4 hours. No Peak, Duration: 24 hours.
2. Once daily Subq injection provides 24 hour coverage.
3. No peak, insulin delivered at steady level, less risk of
hypoglycemia. Often for basal coverage
iii. Monitor for hypoglycemia, hypokalemia, lipodystrophy
iv. Always have oral carbohydrate available.
, v. DO NOT mix with any other insulin (NO peak, NO mix)
e. Combination Insulin (Pre-mixed)
i. Common examples: Humulin 70/30, NovoLog
ii. Mix 70/30 Humalog Mix 75/25, Humalog Mix 50/50,
iii. Intermediate Acting Insulin combined with either Rapid Acting or Short
Acting
iv. (Regular) Insulin.
1. Onset and Peak depend on whether combined with a Rapid Acting
or Short Acting Insulin. All provide 24 hour duration.
v. Monitor for hypoglycemia, hypokalemia, lipodystrophy.
vi. Need Food Coverage with Insulin are Lispro and Aspart
f. Levemir/Lantus Long Acting (Once a day at bedtime)
g. Always check the insulin client first as they might go into hypoglycemia. Normal
glucose level (70-99)
4. How and when to administer different types of insulin (rapid- and short-acting before
meals, intermediate twice a day, long-acting at night)
a. Regular insulin is the only insulin that can be given other than subQ
b. Syringes have to match your concentration grading.
c. NPH insulin is cloudy- mix NPH and regular- clear before cloudy
d. What insulin for food coverage- lispro aspart, rapid acting or regular for meals
e. Long acting insulin at bedtime once per day
f. !!Rapid acting and regular insulin must follow up with food!!
g. Rapid and short-acting before meals, intermediate twice a day, long-acting at
night)
h. Long-acting insulin (Lantus/Levemir) are given once per day at bedtime
5. Know beta-blockers. Beta-blockers and hypoglycemia
a. Beta blockers- ends in lol- most significant side effect bradycardia, effects
asthma- no beta blockers for asthma may cause bronchospasms
b. Beta blockers- slow heart rate and may drop BP- if BP is low do not give beta
blockers call DR; may increase AV heart blocks, monitor
c. Beta blockers can mask symptoms of hypoglycemia- very dangerous
d. Use caution with using Beta-Blockers (-lol) in combination with insulin because it
can mask symptoms of HYPOGLYCEMIA
6. Review glipizide administration, side-effects, alcohol consumption
a. Glipizide is a sulfonylurea used to stimulate the secretion of insulin and decrease
stimulation of glucagon.
b. Used in early type 2 diabetes when the A1C is elevated after metformin use
c. SE: hypoglycemia
d. Alcohol will cause disulfiram-like reaction - syndrome includes flushing,
palpitations, and nausea. Can potentiate the hypoglycemic effects
e. Give 30 mins before breakfast daily if ER, or 2x daily if IR.
f. Can take if renal failure, but should not if liver disease.
7. Review acarbose administration, side-effects, interactions, etc.
a. Acarbose is used as a type 2 oral antidiabetic that blocks enzyme alpha
glucosidase decreasing and delaying intestinal absorption of glucose. Control
postprandial glucose levels.
b. Delays absorptions of carbs and reduces blood glucose rise after meals.
Please review general tips from Quiz review document (test taking strategies, select all that
apply questions, etc.). The test will utilize Respondus browser and monitor (using webcam). No
notes or textbook allowed on the test. Calculator will be enabled in the browser
.
General tips for studying:
1. Memorize names of medication categories from the presentation
2. Memorize key drugs from categories above (there are many questions with specific drug
names)
3. Use generic names
4. When reviewing particular drugs note category, indications, common side effects, toxicity
signs (if applicable), reversal agents, mechanism of action (e.g. agonizing or
antagonizing which receptors)
5. Read question instructions (there will be ‘select all that apply’ questions)
Topics to review:
1. What to monitor in patients on insulin therapy, NPO status and insulin therapy
a. Blood glucose level: 70-110 is optimal. Above 110 is hyperglycemic and less than
70 is hypoglycemic.
b. If above a certain range, we may give insulin on a sliding scale.
c. If NPO and hypoglycemia, the nurse should prepare to administer IV D50 so the
patient does not have anything to eat or drink but is still able to get a sugar
glucose solution quickly to increase the blood glucose level. After this is done,
the BG level should be rechecked.
d. If you give insulin and the patient don’t want to eat it, is a big deal- hypoglycemia
e. If you have a patient who is NPO and they just received insulin and their blood
sugar drops below 70 that is a cause of concern.
2. Signs of hypoglycemia
a. S/S: BG level less than 70, mild shakiness, mental confusion, sweating,
palpitations, headache, lack of coordination, blurry vision, seizures, coma, cold,
pale, irritable, hungry. “Cold and Clammy needs candy”
b. Hypoglycemia rule of 15: check BG level, if less than 70- give 15 g carb or IV
D50 if unable to take PO carbs, wait 15 mins and recheck. Upon recheck, if still
, less than 70- give another 15 g carbs and wait 15 mins and recheck and call
HCP. If still under 70 after 3rd BG recheck, give IV D50 and call HCP as this
could mean something serious is occurring.
c. Good sources of 15 g carbs: 4 oz fruit juice, 1 cup milk, 1 tbsp honey, 1 tbsp
sugar, 6-8 pieces of candy, soda.
d. Once the blood sugar returns, give a complex carb like peanut butter crackers.
3. Memorize insulin names by categories (rapid, short, intermediate, long-acting, and
mixed)
a. Rapid Acting Insulin
i. Common examples: Aspart (NovoLog), Lispro (Humalog), Glulisine
(Apidra)
1. Onset: 5-15 minutes. Administer with meals. DO NOT administer
unless a meal is readily available.
2. Peak: 1-3 hours
3. Duration: 3-5 hours.
ii. Monitor for hypoglycemia, hypokalemia, lipodystrophy.
iii. Always have oral carbohydrate available.
iv. May be given as a short-term IV therapy with very close monitoring
b. Short Acting Insulin (Regular)
i. Common examples: Humulin R, Novolin R,
1. Onset: 30 minutes to 1 hour
2. Peak: 2-4 hours
3. Duration: 6-8 hours.
ii. Used for dosing patients with Sliding Scale
iii. Can be administered IVP or via continuous infusion.
iv. Monitor for hypoglycemia, hypokalemia, lipodystrophy.
v. Always have oral carbohydrate available.
c. Intermediate Acting Insulin
i. Common examples: Isophane suspension (NPH, Humulin N, Novolin N)
1. Onset: 1-1.5 hours,
2. Peak: 6-12 hours
3. Duration: 18-24 hours.
ii. Cloudy suspension. Can mix with Regular or Rapid Acting Insulin, draw
up clear
1. (Regular or Rapid Acting) then cloudy (NPH), “Clear to Cloudy.”
iii. Monitor for hypoglycemia, hypokalemia, lipodystrophy.
iv. Always have oral carbohydrate available.
d. Long-Acting Insulin
i. Common examples: Glargine (Lantus), Levemir, Detemir
ii. For Long lasting remember: Levemir/Detemir “last all year”, Glargine is
Large lasting or Lantus is like a lantern that burns all night
1. Onset: 2-4 hours. No Peak, Duration: 24 hours.
2. Once daily Subq injection provides 24 hour coverage.
3. No peak, insulin delivered at steady level, less risk of
hypoglycemia. Often for basal coverage
iii. Monitor for hypoglycemia, hypokalemia, lipodystrophy
iv. Always have oral carbohydrate available.
, v. DO NOT mix with any other insulin (NO peak, NO mix)
e. Combination Insulin (Pre-mixed)
i. Common examples: Humulin 70/30, NovoLog
ii. Mix 70/30 Humalog Mix 75/25, Humalog Mix 50/50,
iii. Intermediate Acting Insulin combined with either Rapid Acting or Short
Acting
iv. (Regular) Insulin.
1. Onset and Peak depend on whether combined with a Rapid Acting
or Short Acting Insulin. All provide 24 hour duration.
v. Monitor for hypoglycemia, hypokalemia, lipodystrophy.
vi. Need Food Coverage with Insulin are Lispro and Aspart
f. Levemir/Lantus Long Acting (Once a day at bedtime)
g. Always check the insulin client first as they might go into hypoglycemia. Normal
glucose level (70-99)
4. How and when to administer different types of insulin (rapid- and short-acting before
meals, intermediate twice a day, long-acting at night)
a. Regular insulin is the only insulin that can be given other than subQ
b. Syringes have to match your concentration grading.
c. NPH insulin is cloudy- mix NPH and regular- clear before cloudy
d. What insulin for food coverage- lispro aspart, rapid acting or regular for meals
e. Long acting insulin at bedtime once per day
f. !!Rapid acting and regular insulin must follow up with food!!
g. Rapid and short-acting before meals, intermediate twice a day, long-acting at
night)
h. Long-acting insulin (Lantus/Levemir) are given once per day at bedtime
5. Know beta-blockers. Beta-blockers and hypoglycemia
a. Beta blockers- ends in lol- most significant side effect bradycardia, effects
asthma- no beta blockers for asthma may cause bronchospasms
b. Beta blockers- slow heart rate and may drop BP- if BP is low do not give beta
blockers call DR; may increase AV heart blocks, monitor
c. Beta blockers can mask symptoms of hypoglycemia- very dangerous
d. Use caution with using Beta-Blockers (-lol) in combination with insulin because it
can mask symptoms of HYPOGLYCEMIA
6. Review glipizide administration, side-effects, alcohol consumption
a. Glipizide is a sulfonylurea used to stimulate the secretion of insulin and decrease
stimulation of glucagon.
b. Used in early type 2 diabetes when the A1C is elevated after metformin use
c. SE: hypoglycemia
d. Alcohol will cause disulfiram-like reaction - syndrome includes flushing,
palpitations, and nausea. Can potentiate the hypoglycemic effects
e. Give 30 mins before breakfast daily if ER, or 2x daily if IR.
f. Can take if renal failure, but should not if liver disease.
7. Review acarbose administration, side-effects, interactions, etc.
a. Acarbose is used as a type 2 oral antidiabetic that blocks enzyme alpha
glucosidase decreasing and delaying intestinal absorption of glucose. Control
postprandial glucose levels.
b. Delays absorptions of carbs and reduces blood glucose rise after meals.
