WorksheetsMetformin and Sulfonylureas (Glipizide/Glyburide) Worksheet
Total questions: 100
Worksheet time: 55mins
Metformin primarily works by:
Stimulating insulin secretion
Decreasing hepatic glucose production
Increasing carbohydrate absorption
Promoting glycogen breakdown
Which condition requires metformin to be held?
Before receiving IV contrast dye
During hypoglycemia
After exercise
With insulin therapy
The nurse should monitor which lab in a client taking metformin?
Serum calcium
Serum potassium
Serum creatinine
Serum sodium
Glipizide lowers blood glucose by:
Stimulating pancreatic insulin secretion
Decreasing carbohydrate absorption
Reducing insulin resistance
Increasing glucose excretion
A client on glyburide reports dizziness and sweating. What should the nurse do first?
Give a glass of orange juice
Administer sliding-scale insulin
Check urine ketones
Give metformin
What teaching is most important for a client taking glipizide?
“Avoid alcohol to prevent adverse reactions.”
“Take it at bedtime.”
“Increase fiber intake.”
“Expect mild diarrhea.”
When should a client take nateglinide?
At bedtime
30 minutes before a meal
On an empty stomach before fasting
Immediately after meals
Which instruction is essential for clients taking meglitinides?
“Skip the dose if you skip a meal.”
“Take it only in the morning.”
“Always take with a protein snack.”
“Avoid carbohydrates after taking it.”
The nurse explains that acarbose works by:
Stimulating insulin release
Slowing carbohydrate absorption in the intestine
Decreasing glucose excretion
Enhancing insulin sensitivity
Which side effect is most common with alpha-glucosidase inhibitors?
Constipation
Gas and bloating
Dizziness
Weight gain
When teaching a client about acarbose, the nurse should say:
Take it with the first bite of each meal.
Take it one hour before eating.
Take it at bedtime.
Skip the dose if eating dessert.
The nurse monitors a client on pioglitazone for which condition?
Heart failure
Hypoglycemia
Pioglitazone improves glucose control by:
Stimulating pancreatic insulin release
Increasing insulin sensitivity
Decreasing glucose absorption
Promoting glucose excretion
A patient taking pioglitazone should be instructed to report:
Weight loss
Shortness of breath and swelling
Headache
Constipation
Sitagliptin lowers blood sugar by:
Slowing glucose absorption
Increasing insulin and decreasing glucagon release
Enhancing hepatic glucose output
Increasing urine glucose excretion
Which serious adverse effect can occur with sitagliptin?
Pancreatitis
Heart failure
Renal failure
Anemia
Which assessment finding should prompt the nurse to hold sitagliptin and notify the provider?
Fever
Abdominal pain radiating to the back
Polyuria
Dry mouth
The nurse knows SGLT2 inhibitors lower glucose by:
Reducing insulin resistance
Increasing urinary glucose excretion
Enhancing pancreatic beta cell activity
Blocking glucagon receptors
Which side effect is associated with canagliflozin?
Yeast infection
Constipation
Vision changes
Tremors
Which finding is most concerning for a client on an SGLT2 inhibitor?
Increased urination
Dizziness and hypotension
Mild thirst
Fatigue
GLP-1 receptor agonists lower glucose by:
Increasing insulin and decreasing glucagon
Blocking carbohydrate absorption
Decreasing insulin sensitivity
Increasing glycogen breakdown
Which common benefit of semaglutide should the nurse include in teaching?
Weight gain prevention
Weight loss and satiety
Increased appetite
Reduced urine output
Which adverse effect of liraglutide requires immediate reporting?
Headache
Abdominal pain radiating to back
Constipation
Metallic taste
Pramlintide primarily acts to:
Increase insulin secretion
Slow gastric emptying and reduce glucagon release
Increase glucose absorption
Stimulate liver glycogen breakdown
When giving pramlintide with insulin, what is the major risk?
Hypertension
Hypoglycemia
Hyperkalemia
Hyperglycemia
Which insulin should be given with meals?
Lispro (Humalog)
Glargine (Lantus)
NPH
Detemir (Levemir)
A client receiving regular insulin should expect it to peak in:
15 minutes
2 to 3 hours
6 hours
No peak
Which insulin has no defined peak and lasts up to 24 hours?
NPH
Glargine (Lantus)
Regular
Lispro
The nurse explains that NPH insulin peaks between:
1–2 hours
4–12 hours
16–24 hours
30 minutes
When mixing NPH and Regular insulin, which is drawn first?
NPH
Regular
Either order
Depends on syringe type
The nurse identifies hypoglycemia by which finding?
Fruity breath
Diaphoresis and tremors
Deep Kussmaul respirations
Dry mucous membranes
Which insulin complication causes fruity breath and Kussmaul respirations?
Hypoglycemia
DKA
HHS
Hypercalcemia
What is the “Rule of 15” for hypoglycemia?
Give 15 g of fast carbs, recheck in 15 min
Give 15 units insulin
Give 15 g protein
Recheck in 30 min
The nurse should rotate insulin injection sites primarily to prevent:
Skin bruising
Lipohypertrophy
Infection
Poor absorption
Which drug combination increases risk for hypoglycemia?
Insulin and glipizide
Metformin and pioglitazone
Pioglitazone and sitagliptin
Metformin and canagliflozin
Which insulin has the fastest onset of action?
Regular (Humulin R)
NPH (Humulin N)
Lispro (Humalog)
A nurse administers Lispro (Humalog) at 8:00 AM. When should the nurse ensure the client begins eating?
Within 15 minutes
Within 1 hour
After blood sugar drops
2 hours after injection
The nurse prepares to give Regular insulin at 7:30 AM. When should the nurse expect the insulin to peak?
A. 8:00–8:30 AM
B. 9:30–10:30 AM
C. 11:30 AM–12:00 PM
D. 2:00 PM
Which insulin is considered intermediate-acting?
Regular (Humulin R)
NPH (Humulin N)
Lispro (Humalog)
Glargine (Lantus)
The nurse is aware that NPH insulin typically peaks:
1–2 hours
4–12 hours
16–24 hours
No peak
Which insulin is long-acting and has no defined peak?
A. Glargine (Lantus)
B. NPH (Humulin N)
What is the expected duration of action for insulin glargine (Lantus)?
4–6 hours
8–12 hours
16–24 hours
30 minutes
The nurse is teaching a client about insulin detemir (Levemir). Which statement shows correct understanding?
It will cover my meals.
It provides basal control all day.
I can mix it with regular insulin.
It peaks around lunchtime.
Which insulin cannot be mixed with any other insulin?
Regular (Humulin R)
NPH (Humulin N)
Glargine (Lantus)
Lispro (Humalog)
The nurse prepares to mix NPH and Regular insulin. Which step is correct?
Draw up NPH first
Draw up Regular first
Shake both vials
Use separate syringes
A nurse is teaching a client about insulin storage. Which statement is correct?
Keep opened insulin at room temperature for 28 days.
Freeze unused insulin.
When teaching a client about insulin injection sites, which instruction is correct?
A. “Rotate injection sites within the same anatomical area.”
B. “Always use the same exact spot.”
C. “Massage after injection to increase absorption.”
D. “Inject into muscle for faster effect.”
A client injects insulin into the thigh before exercising. What is the nurse’s best response?
That’s a good site choice.
Avoid using the thigh before exercise.
You should inject into your arm only.
Exercise doesn’t affect insulin absorption.
Which insulin type is used in IV administration during DKA?
NPH
Regular (Humulin R)
Lispro
Glargine
The nurse explains that insulin glargine (Lantus) provides:
Short-term meal coverage
Basal control for 24 hours
Coverage for 4 hours only
Immediate blood sugar lowering
Which combination insulin contains both rapid- and intermediate-acting insulin?
Novolog Mix 70/30
Glargine
The nurse knows the purpose of basal-bolus therapy is to:
Use oral drugs to avoid insulin
Mimic the body’s normal insulin pattern
Prevent hypoglycemia completely
Replace rapid-acting insulin
A patient’s glucose drops to 58 mg/dL after taking insulin. What symptom does the nurse expect?
Fruity breath
Tremors and diaphoresis
Deep respirations
Flushed, dry skin
Which teaching is correct for a patient using an insulin pen?
“Prime the pen before each use.”
“Shake the pen vigorously.”
“Store it lying flat in sunlight.”
“Use the same needle multiple times.”
The nurse administers insulin at 8:00 AM and the client becomes diaphoretic and shaky at 9:30 AM. Which insulin is likely the cause?
Lispro (Humalog)
NPH
Glargine
Detemir
Which action best prevents lipohypertrophy?
Which insulin would the nurse expect to give once daily at bedtime?
Lantus (Glargine)
Lispro
Regular
NPH
The nurse educates a client to avoid injecting insulin into:
The abdomen
Areas with scar tissue or bruising
The upper arm
The thigh
When drawing up mixed insulin doses, why is regular insulin drawn first?
To prevent contamination of short-acting insulin
To mix faster
To ensure full absorption
To maintain color consistency
A patient’s blood sugar is 70 mg/dL before scheduled insulin. What should the nurse do?
Hold insulin and notify provider
Administer as ordered
Give half the dose
Give insulin after eating
The nurse knows that skipping meals while taking insulin increases the risk for:
(a)
What is the onset time for Regular insulin?
10–30 minutes
30–60 minutes
2 hours
4 hours
A patient receives NPH insulin at 7:00 AM. The nurse should monitor for hypoglycemia at:
8:00 AM
11:00 AM–3:00 PM
5:00 PM
Bedtime
The nurse recognizes that premixed insulin (70/30) should be administered:
1 hour before meals
30 minutes before meals
At bedtime
Without regard to meals
Which nursing action is appropriate when administering insulin to a hospitalized patient?
Check blood glucose before each dose
Skip if the patient is NPO without checking
Use another nurse’s insulin syringe
Give subcutaneously at any angle
The nurse is teaching a client with type 2 diabetes about metformin (Glucophage). Which statement by the client indicates a need for further teaching?
The nurse knows that glipizide (Glucotrol) lowers blood glucose by:
Decreasing hepatic glucose production
Stimulating insulin release from the pancreas
Blocking carbohydrate absorption in the intestine
Increasing glucose excretion through urine
Which diabetes medication class increases insulin release, decreases glucagon, and decreases gluconeogenesis?
Thiazolidinediones
DPP-4 inhibitors
Alpha-glucosidase inhibitors
SGLT-2 inhibitors
The nurse should monitor for which serious side effect in a patient taking pioglitazone (Actos)?
Pancreatitis
Heart failure and bladder cancer
Lactic acidosis
Hypoglycemia
A client prescribed acarbose (Precose) should be instructed to:
Take the drug with the first bite of each meal
Take it 1 hour before meals
Take it at bedtime
Skip a dose if eating more carbohydrates
The nurse is teaching a client starting canagliflozin (Invokana). Which finding should the nurse emphasize to report to the provider?
Dry mouth
Increased urination
Burning on urination or vaginal itching
Mild thirst
A client on semaglutide (Rybelsus) reports persistent upper abdominal pain. What is the priority nursing action?
Encourage small, frequent meals
Notify the healthcare provider
Administer sliding-scale insulin
Reassure that nausea is expected
Which antidiabetic agent is injectable, slows gastric emptying, reduces glucagon, and increases satiety?
Pramlintide (Symlin)
Sitagliptin (Januvia)
Metformin (Glucophage)
Dapagliflozin (Farxiga)
The nurse prepares to give regular insulin (Humulin R) at 7:00 AM before breakfast. When should the nurse anticipate hypoglycemia to be most likely?
7:15–7:45 AM
8:00–10:00 AM
12:00–2:00 PM
3:00–4:00 PM
A patient taking NPH insulin at 7:00 AM is at greatest risk for hypoglycemia during which period?
8–9 AM
11 AM–3 PM
4–6 PM
Before bedtime
Which insulin has no defined peak and a 24-hour duration, making it ideal for basal control?
NPH
Lispro (Humalog)
Glargine (Lantus)
Regular (Humulin R)
The nurse knows that clients taking thiazide diuretics or corticosteroids may need:
Increased insulin doses
Decreased carbohydrate intake
Smaller insulin doses
Beta-blocker therapy
The nurse monitors for hypoglycemia after giving which medication?
Metformin
Glipizide
Pioglitazone
Dapagliflozin
A client with type 1 diabetes reports feeling shaky and dizzy after a morning run. Blood glucose is 58 mg/dL. Which nursing action is appropriate?
Administer glucagon IM
Provide 4 ounces of orange juice
Recheck glucose in 30 minutes
Call the provider immediately
Which combination of diabetes medications can be used together safely?
Metformin and glipizide
Pioglitazone and insulin (avoid—fluid retention)
Sitagliptin and canagliflozin (avoid—hypoglycemia)
Metformin and contrast dye (hold for renal protection)
The nurse is preparing to administer Lispro (Humalog) insulin at 7:30 AM. Breakfast trays are delayed. What should the nurse do?
Administer insulin as scheduled
Hold the dose until breakfast arrives
Give half the dose now, half later
Administer long-acting insulin instead
A nurse instructs a client to mix NPH and Regular insulin in the same syringe. Which step should the nurse teach first?
Inject air into the Regular insulin vial
Withdraw Regular insulin first
Withdraw NPH insulin first
Roll both vials to mix and inject NPH last
Which statement by a client using insulin glargine (Lantus) indicates correct understanding?
I’ll mix it with my short-acting insulin to save injections.
This insulin doesn’t have a peak, so I’m less likely to go low.
I’ll take this insulin with my meals.
I’ll adjust the dose based on my carbohydrate intake.
A nurse reviews a new prescription for metformin in a client scheduled for CT with contrast dye tomorrow. What is the priority action?
Continue metformin as ordered
Hold metformin today and 48 hours after contrast
Give an extra dose for renal protection
Increase IV fluids after the scan
A client taking Sitagliptin (Januvia) reports new onset of abdominal pain radiating to the back with nausea. What should the nurse suspect?
Gallstones
Pancreatitis
Gastritis
Hypoglycemia
The nurse is caring for a client taking Dulaglutide (Trulicity). Which instruction is most appropriate?
Inject this medication right before meals.
You may experience a feeling of fullness.
If you miss a dose, take two next week.
You can stop this medication once your sugars are normal.
Which drug slows carbohydrate absorption and may cause gas and bloating?
Pioglitazone (Actos)
Acarbose (Precose)
Empagliflozin (Jardiance)
Glipizide (Glucotrol)
Which statement is true regarding SGLT2 inhibitors such as Dapagliflozin (Farxiga)?
They decrease glucose absorption in the gut
They increase glucose excretion in the urine
They stimulate pancreatic beta cells directly
They cause hyperkalemia
A client with Type 2 diabetes is prescribed Pioglitazone (Actos). The nurse should monitor closely for which adverse effect?
Weight loss
Fluid retention and edema
Hypoglycemia after meals
Tachycardia
The nurse teaches a client about Semaglutide (Rybelsus). Which statement indicates a need for further teaching?
This medication helps lower my appetite.
I can take this with other oral diabetes medications.
I’ll take this right after eating breakfast.
This medication may help me lose some weight.
The nurse should question which order for a client with chronic kidney disease?
Glipizide
Metformin
Insulin glargine
Sitagliptin
A client receiving NPH insulin becomes diaphoretic and shaky at 2:00 PM. What is the likely cause?
The insulin has peaked
The insulin has worn off
The dose was too small
The client ate too much lunch
The nurse teaches the “Rule of 15” for hypoglycemia. What is the correct first step?
Eat 15 grams of protein
Eat 15 grams of fast-acting carbohydrates
A client with diabetes reports fatigue, fruity breath, and Kussmaul respirations. What medication deficiency likely contributed?
Insulin
Metformin
Dapagliflozin
Sitagliptin
Which combination insulin has both rapid and intermediate components?
Humulin 70/30
Lantus
Novolog
Levemir
The nurse reviews home insulin administration with a client. Which teaching point is most important to reduce lipohypertrophy?
Store insulin at room temperature
Rotate injection sites
Use the same site each time
Massage the area after injection
A client on pramlintide (Symlin) and insulin is at greatest risk for:
Weight gain
Hypoglycemia
Hyperkalemia
Tachycardia
The nurse should anticipate adding which medication for a patient whose A1C remains above 7% on metformin alone?
Liraglutide (Victoza)
Prednisone
Hydrochlorothiazide
Levothyroxine
The nurse is reinforcing teaching for a patient starting Empagliflozin (Jardiance). Which side effect requires immediate reporting?
Mild thirst
Dizziness and hypotension
Weight loss
Increased urination
A client taking Canagliflozin (Invokana) reports foot pain, swelling, and redness. What complication should the nurse suspect?
Hypoglycemia
Urinary tract infection
Possible infection or amputation risk
Hypotension
