Pharmacology Chapter 32

For what will the nurse assess in a patient who is prescribed metformin for treatment of type 2 diabetes? Headache Weight gain Renal function Cholesterol level

Because metformin is excreted by the kidneys, it is necessary to assess the patient's renal function. If the patient's kidneys are not able to excrete the drug, it will accumulate in the patient's system, thereby causing lactic acidosis. Headaches are not caused by metformin. One of the adverse effects of metformin is weight loss, not weight gain. Cholesterol levels may be high in some diabetic patients but can be treated with medications and lifestyle changes.

The nurse finds that a patient with type 2 diabetes mellitus who is taking glipizide is also prescribed sitagliptin. What action will the nurse take? Decrease the oral dose of glipizide Administer both medications simultaneously Notify the prescribing primary health care provider Give both drugs and checks the patient's blood glucose

Concurrent use of glipizide and sitagliptin results in hypoglycemia. Hence, the nurse needs to notify the primary health care provider who ordered the medications to obtain a prescription to change the drug regimen. Reducing the glipizide dose is not safe, because the drug interacts with sitagliptin. Administering both medications will result in hypoglycemia. The nurse does not administer sitagliptin to the patient, because it may compromise the patient's safety.

Which technique is most appropriate regarding mixing insulin when the patient must administer 30 units regular insulin and 70 units NPH insulin in the morning? Use the Z-track method for administration. Draw the medication into two separate syringes but inject it into the same spot. Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin. Administer these insulins at least 10 minutes apart so that you will know when they are working.

Drawing up the regular insulin into the syringe first prevents accidental mixture of NPH insulin into the vial of regular insulin, which could cause an alteration in the onset of action of the regular insulin. Z-track is an intramuscular technique that is not used with insulin. The medications do not have to be in separate syringes and can be administered together.

Which is the most appropriate action for the nurse who is told that a patient typically takes his glipizide with food? Immediately call the health care provider. Immediately check the patient's blood glucose level. Inform the patient that the medication must be taken 15 minutes after a meal. Inform the patient that it is better to take the medication 30 minutes before a meal.

Food inhibits the absorption of glipizide, the only sulfonylurea agent that should be given 30 minutes before a meal. The health care provider does not have to be called; the nurse should intervene. The blood glucose level does not have to be taken right away. The medication is not to be taken after a meal.

What is the best method of administering glipizide? With food At bedtime 15 minutes postprandial 30 minutes before a meal

Glipizide is the only sulfonylurea agent that should be administered 30 minutes before a meal. This is because the insulin secreted by the drug corresponds with the elevation in blood glucose concentrations induced by the meal. Food inhibits the absorption of glipizide. Hence, it cannot be administered with food or in a postprandial stage or at bedtime.

Which are second-generation sulfonylureas? Select all that apply. Glipizide Glyburide Metformin Glimepiride Pioglitazone

Glipizide, glyburide, and glimepiride are second-generation sulfonylureas. Metformin is a biguanide. Pioglitazone is a thiazolidinedione.

Which statement by a nursing student about insulin glargine indicates effective learning? "The duration of action of this insulin is about 8 to 10 hours." "You can mix this insulin with Lente insulin to enhance its effects." "You cannot mix this insulin in the same syringe with regular insulin." "This insulin is injected just before meals because it is very fast acting."

Insulin glargine should not be mixed with any other insulin. It has a duration of action up to 24 hours. It is given alone because of the low pH of the diluent. It is a long-acting insulin that can be given at bedtime to provide up to 24 hours of insulin coverage.

Which statement indicates to the nurse that the patient needs additional teaching on oral hypoglycemic agents? "I will monitor my blood sugar daily." "I will limit my alcohol consumption." "I will take the medication only when I need it." "I will report symptoms of fatigue and loss of appetite."

Oral hypoglycemic agents must be taken on a daily scheduled basis to maintain euglycemia and to prevent long-term complications of diabetes. The patient needs to closely monitor blood sugar. When alcohol is ingested with certain oral hypoglycemic drugs, the hypoglycemic effect can be intensified. The patient may experience fatigue and loss of appetite as side effects of the medication, and these should be reported to the health care provider.

The nurse is teaching a patient who has been prescribed repaglinide. Which information will the nurse include in the teaching plan? "This medication will not cause hypoglycemia." "You will need to be sure you eat as soon as you take this medication." "You do not have to worry about side effects when taking this medication." "When taking this medication, use aspirin rather than acetaminophen for pain relief."

Repaglinide is short acting. The drug's very fast onset of action allows patients to take the drug with meals and skip a dose when they skip a meal. Hypoglycemia is a side effect of this medication, and there are many other possible side effects of this medication. The effects of repaglinide are enhanced when taken with aspirin and other nonsteroidal antiinflammatory drugs, which may result in increased hypoglycemia.

What will the nurse instruct a patient who is prescribed repaglinide for type 2 diabetes to do? You need to eat a meal after each dose." "You can take sulfonylureas with repaglinide." "You can skip one dose if you eat three meals." "Skipping two doses will cause hypoglycemia."

The nurse instructs the patient to eat a meal after each dose, because skipping a meal can cause hypoglycemia. Repaglinide is not combined with sulfonylureas, because they share a similar mechanism of action. The dose must be taken before each meal, and skipping either the meal or the dose will fluctuate the glucose levels in the body. Skipping two doses of repaglinide will cause hyperglycemia in the patient, because glucose levels will increase.

An unconscious patient is brought to the emergency department after experiencing a seizure. The family members report the patient experienced tremors, sweating, and irritability before losing consciousness. The patient's laboratory results indicate hypoglycemia. Which medication does the nurse expect will be ordered by the health care provider? Insulin Glucagon Exenatide Liraglutide

Tremors, sweating, irritability, seizure activity, and unconsciousness are all clinical manifestations of hypoglycemia. The treatment of choice for this patient is an intravenous infusion of glucagon. Insulin should never be given to a patient who is already hypoglycemic. Exenatide and liraglutide are incretins that would be appropriate to treat hyperglycemia, not hypoglycemia. pg 514

Which statement made by the patient about type 1 diabetes mellitus indicates effective learning? The endogenous insulin levels are elevated early in the disease. Type 1 diabetes mellitus accounts for 90% of all diabetic cases. Patients with type 1 diabetes mellitus require exogenous insulin. Type 1 diabetes mellitus leads to developing acute hypoglycemia.

Type 1 diabetes involves lack of insulin production. Hence, patients with type 1 diabetes require exogenous insulin to lower the blood glucose level. There is little or no endogenous insulin, as the patient's body is unable to produce insulin. The disease accounts for 10% of all cases and is usually seen in patients younger than 20 years. Type 1 diabetes results in acute hyperglycemia due to lack of insulin.

Which class of medication increases blood glucose levels when administered with insulin? Diuretics Salicylates Sulfa antibiotics Anabolic steroids

When a diuretic is administered with insulin, an increased blood glucose level will result, because the diuretic antagonizes the effect of insulin. Salicylates, sulfa antibiotics, and anabolic steroids will increase the risk of hypoglycemia when administered with insulin.