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A client who is receiving metformin develops lactic acidosis. When planning the care for this client, which nursing diagnosis would the nurse most likely identify?
- A. Ineffective Breathing Pattern
- B. Risk for Fluid Volume Deficit
- C. Acute Confusion
- D. Anxiety
Correct Answer: A
Rationale: When taking metformin, the patient is at risk for lactic acidosis manifested by unexplained hyperventilation, myalgia, malaise, GI symptoms, or unusual somnolence. Thus, a nursing diagnosis of Ineffective Breathing Pattern would be most likely. There are no problems with fluid balance. Acute Confusion would be appropriate if the client was experiencing hypoglycemia. Anxiety would be appropriate for a client who is newly diagnosed with diabetes and having difficulty accepting the diagnosis.
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A nurse is preparing to administer a long-acting insulin to a client. Which of the following might the nurse administer?
- A. Insulin aspart (NovoLog)
- B. Insulin lispro (Humalog)
- C. Insulin glargine (Lantus)
- D. Insulin detemir (Levemir)
- E. Insulin glulisine (Apidra)
Correct Answer: C,D
Rationale: Insulin glargine (Lantus) and insulin detemir (Levemir) are long-acting insulins with a duration of 24 hours. Insulin aspart, lispro, and glulisine are rapid-acting insulins.
After teaching a group of nursing students about antidiabetic drugs, the instructor determines that the teaching was successful when the students identify which of the following as producing the glucose-lowering effects by delaying the digestion and absorption of carbohydrates in the intestine?
- A. Glimepiride (Amaryl)
- B. Metformin (Glucophage)
- C. Pioglitazone (Actos)
- D. Miglitol (Glyset)
- E. Acarbose (Precose)
Correct Answer: D,E
Rationale: 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. Glimepiride is a sulfonylurea. Metformin sensitizes the liver to circulating insulin levels and reduces hepatic glucose production. Pioglitazone decreases insulin resistance and increases insulin sensitivity by modifying several processes, resulting in decreased hepatic glucogenesis (formation of glucose from glycogen) and increased insulin-dependent muscle glucose uptake.
A client has been prescribed acarbose. Which of the following interventions should the nurse perform to promote an optimal response to the medication?
- A. Administer the drug with breakfast.
- B. Expect to add an oral sulfonylurea with the drug bends
- C. Administer the drug with the first bite of the meal.
- D. Report unusual somnolence to the primary health care provider.
Correct Answer: C
Rationale: The nurse should administer acarbose to the client with the first bite of the meal. The nurse needs to administer glyburide (Micronase) with breakfast. An oral sulfonylurea will likely be added to metformin if the client does not experience a response in 4 weeks using the maximum dose of metformin. Clients taking metformin may experience unusual somnolence, of which the nurse should inform the primary health care provider.
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.
A nurse should monitor a client taking glyburide (DiaBeta) for increased hypoglycemic effect if which of the following drugs are initiated?
- A. Ranitidine (Zantac)
- B. Warfarin (Coumadin)
- C. Digoxin (Lanoxin)
- D. Lithium (Eskalith)
- E. Amitriptyline (Elavil)
Correct Answer: A,B,E
Rationale: H2 antagonists (ranitidine), anticoagulants (warfarin), and tricyclic antidepressants (amitriptyline), among others, can result in increased hypoglycemic effects of sulfonylureas (glyburide).