Nokea
A client is receiving metformin (Glucophage). The nurse suspects that the client is developing lactic acidosis based on assessment of which of the following?
- A. Malaise
- B. Hypertension
- C. Tachypnea
- D. Abdominal pain
- E. Muscular pain
Correct Answer: A,C,D,E
Rationale: Symptoms of lactic acidosis include malaise, abdominal pain, tachypnea, shortness of breath, and muscular pain.
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Which of the following produce their glucose-lowering effect by decreasing insulin resistance and increasing insulin sensitivity?
- A. Rosiglitazone (Avandia)
- B. Metformin (Glucophage)
- C. Pioglitazone (Actos)
- D. Miglitol (Glyset)
- E. Acarbose (Precose)
Correct Answer: A,C
Rationale: The thiazolidinediones, rosiglitazone (Avandia) and pioglitazone (Actos), produce their glucose-lowering effect by decreasing insulin resistance and increasing insulin sensitivity. The alpha-glucosidase inhibitors, acarbose (Precose) and miglitol (Glyset), produce their glucose-lowering effects by delaying the digestion and absorption of carbohydrates in the intestine. Metformin sensitizes the liver to circulating insulin levels and reduces hepatic glucose production.
As part of the ongoing assessment of a client receiving insulin detemir, the nurse would suspect that the insulin is not effective based on assessment of which of the following?
- A. Increased thirst
- B. Increased urination
- C. Increased appetite
- D. Confusion
- E. Abdominal pain
Correct Answer: A,B,E
Rationale: If the insulin was not effective, the client would exhibit signs and symptoms of hyperglycemia including drowsiness, dim vision, thirst, nausea, vomiting, abdominal pain, loss of appetite, acetone breath, and excessive urination.
A nurse is caring for a client receiving insulin detemir 10 units at bedtime. Which of the following drugs, if started, would most likely require a decrease in the dosage of insulin?
- A. Sulfamethoxazole/trimethoprim (Septra)
- B. Metoprolol (Lopressor)
- C. Fenofibrate (Tricor)
- D. Diltiazem (Verapamil)
- E. Albuterol (Ventolin)
Correct Answer: A,B,C
Rationale: Sulfonamides (sulfamethoxazole/trimethoprim), beta-blocking drugs (metoprolol), and fibrates (fenofibrate), among others, can increase the effect of insulin and require a decrease in insulin dosage to control the client's diabetes. Diltiazem and albuterol decrease the effect of insulin, requiring an increase in the dosage.
A client is receiving glipizide at a health care facility. The client is also prescribed an anticoagulant. The nurse would be alert for which of the following related to the interaction of these two drugs?
- A. Increased risk of lactic acidosis
- B. Risk of acute renal failure
- C. Increased risk for bleeding
- D. Increased hypoglycemic effect
Correct Answer: D
Rationale: The nurse should observe for increased hypoglycemic effect in the client as the effect of the interaction of sulfonylureas with the anticoagulants, chloramphenicol, clofibrate, fluconazole, histamine-2 antagonists, meth Methyldopa, monoamine oxidase inhibitors (MAOIs), salicylates, sulfonamides, and tricyclic antidepressants. Increased risk of lactic acidosis is an effect of the interaction of metformin with glucocorticoids. Increased risk for bleeding is an effect of the interaction of oral anticoagulants with anti-infective drugs. There is a risk of acute renal failure when iodinated contrast material used for radiologic studies is administered with metformin.
A client at a health care facility has been prescribed diazoxide for hypoglycemia due to hyperinsulinism. After administration, the nurse would assess the client for which adverse reaction?
- A. Myalgia
- B. Tachycardia
- C. Flatulence
- D. Epigastric discomfort
Correct Answer: B
Rationale: The nurse should monitor for tachycardia, congestive heart failure, sodium and fluid retention, hyperglycemia, and glycosuria as the adverse reactions in the client receiving diazoxide drug therapy. Myalgia, fatigue, and headache are the adverse reactions observed in clients undergoing pioglitazone HCl drug therapy. Flatulence is one of the adverse reactions found in clients receiving metformin drug therapy. Epigastric discomfort is one of the adverse reactions observed in clients receiving acetohexamide drugs.