42 Antidiabetic Drugs

A nurse is caring for a client with type 2 diabetes receiving a meglitinide. The nurse reviews the client's medical record based on the understanding that which condition would contraindicate the use of this drug? A) Diabetic ketoacidosis B) Kidney disease C) Severe heart failure D) Liver disease

Ans: A Feedback: Meglitinides are contraindicated in clients with diabetic ketoacidosis and severe endocrine disease. Thiazolidinediones are contraindicated in clients with severe heart failure and used with caution in clients with kidney disease, severe heart failure, and liver disease.

A client is being discharged after being diagnosed with diabetes. The client is being taught how to monitor his blood glucose. After teaching the client, which statement indicates to the nurse that additional teaching is needed? A) I should prick the tip of my finger to get the blood. B) I should clean my finger with warm, soapy water. C) I should massage my finger to get a hanging drop of blood. D) I should avoid smearing the blood on the test strip.

Ans: A Feedback: The client should insert the lancet to prick the side of the finger, not the tip, because the side has more capillaries and fewer nerve endings. The finger should be washed with warm, soapy water and then dried before testing. The client should massage the finger to get a hanging drop of blood to be placed on the test strip. The client needs to avoid smearing the blood on the strip to prevent inaccurate readings.

A nurse at a health care facility is assigned to administer insulin to the client. Which of the following interventions should the nurse perform before administering each insulin dose? A) Inspect the previous injection site for inflammation. B) Keep prefilled syringes horizontally. C) Check for symptoms of myalgia or malaise. D) Mix the insulin with sterile water in the syringe.

Ans: A Feedback: The nurse should check the previous injection site before administering each insulin dose. The injection sites should be rotated to prevent lipodystrophy. Prefilled syringes should not be kept horizontally; they should be kept in a vertical or oblique position to avoid plugging the needle. The nurse checks for symptoms of myalgia or malaise when administration of metformin leads to lactic acidosis. Insulin should not be mixed with other drugs in the syringe. Some types of insulin may be combined in one syringe, but sterile water is never used.

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

Ans: A Feedback: 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.

A nurse is caring for a client with diabetes mellitus who is receiving an oral antidiabetic drug. Which of following ongoing assessments should the nurse perform when caring for this client? A) Assess the skin for ulcers, cuts, and sores. B) Observe the client for hypoglycemic episodes. C) Monitor the client for lipodystrophy. D) Document family medical history.

Ans: B Feedback: As the ongoing assessment activity, the nurse should observe the client for hypoglycemic episodes. Documenting family medical history and assessing the client's skin for ulcers, cuts, and sores should be completed before administering the drug. Lipodystrophy occurs if the sites of insulin injection are not rotated.

A client receives insulin lispro at 8 a.m. The nurse would be alert for signs and symptoms of hypoglycemia at about which time? A) 8:15 a.m. B) 9 a.m. C) 10 a.m. D) 11 a.m.

Ans: B Feedback: Insulin lispro reaches its peak action in 30 minutes to 1.5 hours. Therefore, the client's greatest risk for hypoglycemia would be during this time or about 9 a.m. Onset of action occurs in 5 to 10 minutes, so the drug would begin being effective at this time.

A client is prescribed miglitol. The nurse would instruct the client to administer this drug at which time? A) At bedtime B) Three times a day with the first bite of a meal C) 30 minutes before eating breakfast D) Before or after a meal during the day

Ans: B Feedback: Miglitol is given three times a day with the first bite of the meal because food increases absorption.

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

Ans: B Feedback: 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.

A nurse is assigned to administer insulin glargine to a client at a health care facility. What precaution should the nurse take when administering this drug? A) Administer glargine via IV route. B) Avoid mixing glargine with other insulin. C) Shake the vial vigorously before withdrawing insulin. D) Be sure the insulin has been refrigerated.

Ans: B Feedback: When administering insulin glargine to the client, the nurse should avoid mixing it with other insulins or solutions. It will precipitate in the syringe when mixed. If glargine is mixed with another solution, it will lose glucose control, resulting in decreased effectiveness of the insulin. Glargine is administered via the subcutaneous route once daily at bedtime. The nurse should not shake the vial vigorously before withdrawing insulin. The vial should be gently rotated between the palms of the hands and tilted gently end to end immediately before withdrawing the insulin. The nurse administers insulin from vials at room temperature. Vials are stored in the refrigerator if they are to be stored for about 3 months for later use.

A nurse is caring for a client diagnosed with type 2 diabetes. When teaching the client about this condition, the nurse would identify which of the following as a risk factor? A) Young age B) Regular exercise C) Obesity D) Polyuria

Ans: C Feedback: The nurse informs the client that obesity is a risk factor associated with type 2 diabetes. Young age and regular exercise are not risk factors for type 2 diabetes. Polyuria is a symptom of diabetes and not a risk factor leading to type 2 diabetes.

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. C) Administer the drug with the first bite of the meal. D) Report unusual somnolence to the primary health care provider.

Ans: C Feedback: 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 nurse is caring for a client who has developed a hypoglycemic reaction. Which of the following interventions should the nurse perform if swallowing and gag reflexes are present in the client? A) Administer glucagon by the parenteral route. B) Administer the insulin via insulin pump. C) Administer oral antidiabetics to the client. D) Give oral fluids or candy.

Ans: D Feedback: The nurse should administer oral fluids or candy to the hypoglycemic client with swallowing and gag reflexes. If the client is unconscious, the nurse should administer glucose or glucagon parenterally. The nurse should administer insulin through an insulin pump for diabetic clients who are pregnant or have had a renal transplant. Oral antidiabetic drugs are administered to clients with type 2 diabetes.

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

Ans: D Feedback: 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, 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.