Endocrine Medications

Which type of insulin would the nurse expect to administer to a patient with DKA? A. Regular B. Intermediate-acting C. Long-acting D. Ultra-long-acting

A. Use regular insulin in a patient with circulatory collapse, DKA, or hyperkalemia.

The nurse is caring for a client who is experiencing an insulin reaction. Which of the following is a nursing priority? A. Provide the client with protein B. Give glucagon C. Offer the client a high calorie meal D. Give a dose of insulin

B. During an insulin reaction, the client becomes confused or unconscious due to hypoglycemia. If a client is having an insulin reaction, glucagon can be given to raise the blood sugar. The client may be too obtunded to eat a solid meal.

The nurse is reviewing a client's lab values and notes an A1C of 7.2%. The nurse understands that this signifies which of the following? A. The client has had poor glucose control over a span of several months B. The client is hyperglycemic and needs insulin administered. C. The client has had excellent glucose control over a span of several months D. The client is hypoglycemic and needs to consume a quick acting carbohydrate

A. An A1C measures the amount of glucose that is attached to hemoglobin in red blood cells. This attachment is permanent, and RBCs live for around 3 months, so the A1C reflects a client's glucose control over a 3 month span.

A client must take dexamethasone for treatment of adrenal hyperplasia. Which information should the nurse provide to this client about possible complications associated with this drug? A. Increased infection B. Nephrotic syndrome C. Anemia D. Endocarditis

A. Dexamethasone is a type of corticosteroid that can be used in the management of many types of patient conditions, including adrenal hyperplasia. Steroids, while effective, can cause several negative side effects and should not be used with some clients. For example, dexamethasone can increase a client's risk of infection, so subsequently not be used with an immunocompromised client.

A client uses Novolin R, a short-acting insulin, to control his blood glucose levels. The client is reviewing the principles of glucose control with the nurse and asks about when he should take his insulin in relation to meals. Which response from the nurse is most accurate? A. "Give yourself a dose of this insulin about 30 minutes after you have started eating." B. "This type of insulin should be taken with meals." C. "Take this insulin about a half hour before you eat." D. "You should only take this insulin once a day; it does not coincide with your meals."

A. Novolin R and other types of short-acting insulin preparations are designed to have an onset of approximately 30 to 45 minutes. This means that if a client is getting ready to eat a meal, he should take the insulin about a half hour before eating so that the onset of the insulin will match the time that he eats.

A patient with lupus needs to take corticosteroids for control of symptoms but has developed an electrolyte deficit as a side effect of the drug. Which nutrition strategy should the nurse recommend for the patient that would help to combat this side effect? A. Increase potassium intake by eating bananas and potatoes B. Try to include one protein source per day C. Decrease calcium intake to prevent kidney stones D. Chew food slowly and sip fluid between bites

A. Nutrient deficiency often develops as a side effect of the medication. Common deficiencies include potassium, calcium, and sodium, electrolytes whose excretion is altered by the kidneys in long term use of corticosteroids.

The nurse is teaching the client about his prescribed prednisone. Which statement, if made by the client, indicates that further teaching is necessary? 1. "I can take aspirin or my antihistamine if I need it." 2. "I need to take the medication every day at the same time." 3. "I need to avoid coffee, tea, cola, and chocolate in my diet." 4. "If I gain 5 pounds or more a week, I will call my doctor."

Answer: 1 Rationale: Aspirin and other over-the-counter medications should not be taken unless the client consults with the PHCP. The client needs to take the medication at the same time every day and should be instructed not to stop the medication. A slight weight gain as a result of an improved appetite is expected; however, after the dosage is stabilized, a weight gain of 5 pounds (2.25 kg) or more weekly should be reported to the PHCP. Caffeine-containing foods and fluids need to be avoided because they may contribute to steroid-ulcer development.

The primary health care provider (PHCP) prescribes exenatide for a client with type 1 diabetes mellitus who takes insulin. The nurse should plan to take which most appropriate intervention? 1. Withhold the medication and call the PHCP, questioning the prescription for the client. 2. Teach the client about the signs and symptoms of hypoglycemia and hyperglycemia. 3. Monitor the client for gastrointestinal side effects after administering the medication. 4. Withdraw the insulin from the prefilled pen into an insulin syringe to prepare for administration.

Answer: 1 Rationale: Exenatide is an incretin mimetic used for type 2 diabetes mellitus only. It is not recommended for clients taking insulin. Hence the nurse should withhold the medication and question the PHCP regarding this prescription. Although options 2 and 3 are correct statements about the medication, in this situation the medication should not be administered. The medication is packaged in prefilled pens ready for injection without the need for drawing it up into another syringe.

The nurse is teaching a client with diabetes mellitus how to mix regular insulin and NPH insulin in the same syringe. Which action, if performed by the client, indicates the need for further teaching? 1. Withdraws the NPH insulin first 2. Withdraws the regular insulin first 3. Injects air into NPH insulin vial first 4. Injects an amount of air equal to the desired dose of insulin into each vial

Answer: 1 Rationale: When preparing a mixture of short-acting insulin, such as regular insulin, with another insulin preparation, the short-acting insulin is drawn into the syringe first. This sequence will avoid contaminating the vial of short-acting insulin with insulin of another type. Options 2, 3, and 4 identify correct actions for preparing NPH and short-acting insulin.

The home health care nurse is visiting a client who was recently diagnosed with type 2 diabetes mellitus. The client is prescribed repaglinide and metformin. The nurse should provide which instructions to the client? Select all that apply. 1. Diarrhea may occur secondary to the metformin. 2. The repaglinide is not taken if a meal is skipped. 3. The repaglinide is taken 30 minutes before eating. 4. A simple sugar food item is carried and used to treat mild hypoglycemia episodes. 5. Muscle pain is an expected effect of metformin and may be treated with acetaminophen. 6. Metformin increases hepatic glucose production to prevent hypoglycemia associated with repaglinide.

Answer: 1, 2, 3, 4 Rationale: Repaglinide, a rapid-acting oral hypoglycemic agent that stimulates pancreatic insulin secretion, should be taken before meals (approximately 30 minutes before meals) and should be withheld if the client does not eat. Hypoglycemia is a side effect of repaglinide and the client should always be prepared by carrying a simple sugar at all times. Metformin is an oral hypoglycemic given in combination with repaglinide and works by decreasing hepatic glucose production. A common side effect of metformin is diarrhea. Muscle pain may occur as an adverse effect from metformin, but it might signify a more serious condition that warrants primary health care provider notification, not the use of acetaminophen.

The nurse is monitoring a client receiving levothyroxine sodium for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? Select all that apply. 1. Insomnia 2. Weight loss 3. Bradycardia 4. Constipation 5. Mild heat intolerance

Answer: 1, 2, 5 Rationale: Insomnia, weight loss, and mild heat intolerance are side effects of levothyroxine sodium. Bradycardia and constipation are not side effects associated with this medication, and rather are associated with hypothyroidism, which is the disorder that this medication is prescribed to treat.

A client with diabetes mellitus is taking Humulin NPH insulin and regular insulin every morning. The nurse should provide which instructions to the client? Select all that apply. 1. Hypoglycemia may be experienced before dinnertime. 2. The insulin dose should be decreased if illness occurs. 3. The insulin should be administered at room temperature. 4. The insulin vial needs to be shaken vigorously to break up the precipitates. 5. The NPH insulin should be drawn into the syringe first, then the regular insulin.

Answer: 1, 3 Rationale: Humulin NPH is an intermediate-acting insulin. The onset of action is 60 to 120 minutes, it peaks in 6 to 14 hours, and its duration of action is 16 to 24 hours. Regular insulin is a short-acting insulin. Depending on the type, the onset of action is 30 to 60 minutes, it peaks in 1 to 5 hours, and its duration is 6 to 10 hours. Hypoglycemic reactions most likely occur during peak time. Insulin should be at room temperature when administered. Clients may need their insulin dosages increased during times of illness. Insulin vials should never be shaken vigorously. Regular insulin is always drawn up before NPH.

A client with hyperthyroidism has been given methimazole. Which nursing considerations are associated with this medication? Select all that apply. 1. Administer methimazole with food. 2. Place the client on a low-calorie, low-protein diet. 3. Assess the client for unexplained bruising or bleeding. 4. Instruct the client to report side and adverse effects such as sore throat, fever, or headaches. 5. Use special radioactive precautions when handling the client's urine for the first 24 hours following initial administration.

Answer: 1, 3, 4 Rationale: Common side effects of methimazole include nausea, vomiting, and diarrhea. To address these side effects, this medication should be taken with food. Because of the increase in metabolism that occurs in hyperthyroidism, the client should consume a high-calorie diet. Antithyroid medications can cause agranulocytosis with leukopenia and thrombocytopenia. Sore throat, fever, headache, or bleeding may indicate agranulocytosis and the primary health care provider should be notified immediately. Methimazole is not radioactive and should not be stopped abruptly, due to the risk of thyroid storm.

The nurse should tell the client who is taking levothyroxine to notify the primary health care provider (PHCP) if which problem occurs? 1. Fatigue 2. Tremors 3. Cold intolerance 4. Excessively dry skin

Answer: 2 Rationale: Excessive doses of levothyroxine can produce signs and symptoms of hyperthyroidism. These include tachycardia, chest pain, tremors, nervousness, insomnia, hyperthermia, extreme heat intolerance, and sweating. The client should be instructed to notify the PHCP if these occur. Options 1, 3, and 4 are signs of hypothyroidism.

The home care nurse visits a client recently diagnosed with diabetes mellitus who is taking Humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin. The nurse should tell the client to take which action? 1. Freeze the insulin. 2. Refrigerate the insulin. 3. Store the insulin in a dark, dry place. 4. Keep the insulin at room temperature.

Answer: 2 Rationale: Insulin in unopened vials should be stored under refrigeration until needed. Vials should not be frozen. When stored unopened under refrigeration, insulin can be used up to the expiration date on the vial. Options 1, 3, and 4 are incorrect.

The nurse is providing instructions to the client newly diagnosed with diabetes mellitus who has been prescribed pramlintide. Which instruction should the nurse include in the discharge teaching? 1. "Inject the pramlintide at the same time you take your other medications." 2. "Take your prescribed pills 1 hour before or 2 hours after the injection." 3. "Be sure to take the pramlintide with food so you don't upset your stomach." 4. "Make sure you take your pramlintide immediately after you eat so you don't experience a low blood sugar."

Answer: 2 Rationale: Pramlintide is used for clients with types 1 and 2 diabetes mellitus who use insulin. It is administered subcutaneously before meals to lower blood glucose level after meals, leading to less fluctuation during the day and better long-term glucose control. Because pramlintide delays gastric emptying, any prescribed oral medications should be taken 1 hour before or 2 hours after an injection of pramlintide; therefore, instructing the client to take his or her pills 1 hour before or 2 hours after the injection is correct. Pramlintide should not be taken at the same time as other medications. Pramlintide is given immediately before the meal in order to control postprandial rise in blood glucose, not necessarily to prevent stomach upset. It is incorrect to instruct the client to take the medication after eating, as it will not achieve its full therapeutic effect.

A client with diabetes mellitus visits a health care clinic. The client's diabetes mellitus previously had been well controlled with glyburide daily, but recently the fasting blood glucose level has been 180 to 200 mg/dL (10 to 11.1 mmol/L). Which medication, if added to the client's regimen, may have contributed to the hyperglycemia? 1. Atenolol 2. Prednisone 3. Phenelzine 4. Allopurinol

Answer: 2 Rationale: Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements. Option 1, a beta blocker, and option 3, a monoamine oxidase inhibitor, have their own intrinsic hypoglycemic activity. Option 4 decreases urinary excretion of sulfonylurea agents, causing increased levels of the oral agents, which can lead to hypoglycemia.

Glimepiride is prescribed for a client with diabetes mellitus. The nurse instructs the client that which food items are most acceptable to consume while taking this medication? Select all that apply. 1. Alcohol 2. Red meats 3. Whole-grain cereals 4. Low-calorie desserts 5. Carbonated beverages

Answer: 2, 3, 5 Rationale: When alcohol is combined with glimepiride, a disulfiram-like reaction may occur. This syndrome includes flushing, palpitations, and nausea. Alcohol can also potentiate the hypoglycemic effects of the medication. Clients need to be instructed to avoid alcohol consumption while taking this medication. Low-calorie desserts should also be avoided. Even though the calorie content may be low, carbohydrate content is most likely high and can affect the blood glucose. The items in options 2, 3, and 5 are acceptable to consume.

The nurse teaches the client who is newly diagnosed with diabetes insipidus about the prescribed intranasal desmopressin. Which statements by the client indicate understanding? Select all that apply. 1. "This medication will turn my urine orange." 2. "I should decrease my oral fluids when I start this medication." 3. "The amount of urine I make should increase if this medicine is working." 4. "I need to follow a low-fat diet to avoid pancreatitis when taking this medicine." 5. "I should report headache and drowsiness to my doctor since these symptoms could be related to my desmopressin."

Answer: 2, 5 Rationale: In diabetes insipidus, there is a deficiency in antidiuretic hormone (ADH), resulting in large urinary losses. Desmopressin is an antidiuretic hormone that enhances reabsorption of water in the kidney. Clients with diabetes insipidus drink high volumes of fluid (polydipsia) as a compensatory mechanism to counteract urinary losses and maintain fluid balance. Once desmopressin is started, oral fluids should be decreased to prevent water intoxication. Therefore, clients with diabetes insipidus should decrease their oral fluid intake when they start desmopressin. Headache and drowsiness are signs of water intoxication in the client taking desmopressin and should be reported to the primary health care provider. Desmopressin does not turn urine orange. The amount of urine should decrease, not increase, when desmopressin is started. Desmopressin does not cause pancreatitis.

A daily dose of prednisone is prescribed for a client. The nurse provides instructions to the client regarding administration of the medication and should instruct the client that which time is best to take this medication? 1. At noon 2. At bedtime 3. Early morning 4. Any time, at the same time, each day

Answer: 3 Rationale: Corticosteroids (glucocorticoids) should be administered before 9 a.m. Administration at this time helps minimize adrenal insufficiency and mimics the burst of glucocorticoids released naturally by the adrenal glands each morning. Options 1, 2, and 4 are incorrect.

The nurse is providing discharge teaching for a client newly diagnosed with type 2 diabetes mellitus who has been prescribed metformin. Which client statement indicates the need for further teaching? 1. "It is okay if I skip meals once in a while." 2. "I need to let my doctor know if I get unusually tired." 3. "I need to constantly watch for signs of low blood sugar." 4. "I will be sure to not drink alcohol excessively while on this medication."

Answer: 3 Rationale: Metformin is classified as a biguanide and is the most commonly used medication for type 2 diabetes mellitus initially. It is also often used as a preventive medication for those at high risk for developing diabetes mellitus. When used alone, metformin lowers the blood glucose after meal intake as well as fasting blood glucose levels. Metformin does not stimulate insulin release and therefore poses little risk for hypoglycemia. For this reason, metformin is well suited for clients who skip meals. Unusual somnolence as well as hyperventilation, myalgia, and malaise are early signs of lactic acidosis, a toxic effect associated with metformin. If any of these signs or symptoms occur, the client should inform the primary health care provider immediately. While it is best to avoid consumption of alcohol, it is not always realistic or feasible for clients to quit drinking altogether; for this reason, clients should be informed that excessive alcohol intake can cause an adverse reaction with metformin.

The nurse provides instructions to a client who is taking levothyroxine. The nurse should tell the client to take the medication in which way? 1. With food 2. At lunchtime 3. On an empty stomach 4. At bedtime with a snack

Answer: 3 Rationale: Oral doses of levothyroxine should be taken on an empty stomach to enhance absorption. Dosing should be done in the morning before breakfast.

The client with hyperparathyroidism is taking alendronate. Which statements by the client indicate understanding of the proper way to take this medication? Select all that apply. 1. "I should take this medication with food." 2. "I should take this medication at bedtime." 3. "I should sit up for at least 30 minutes after taking this medication." 4. "I should take this medication first thing in the morning on an empty stomach." 5. "I can pick a time to take this medication that best fits my lifestyle as long as I take it at the same time each day."

Answer: 3, 4 Rationale: Alendronate is a bisphosphonate used in hyperparathyroidism to inhibit bone loss and normalize serum calcium levels. Esophagitis is an adverse effect of primary concern in clients taking alendronate. For this reason the client is instructed to take alendronate first thing in the morning with a full glass of water on an empty stomach, not to eat or drink anything else for at least 30 minutes after taking the medication, and to remain sitting upright for at least 30 minutes after taking it.

The nurse is monitoring a patient receiving prednisone. For which adverse reaction should the nurse monitor the patient? A. Somnolence B. Hyperglycemia C. Hyperkalemia D. Hypercalcemia

B. Corticosteroids affect almost all body systems. Endocrine system reactions may include decreased glucose tolerance, resulting in hyperglycemia and possibly precipitating diabetes mellitus.

During the physical assessment of a comprehensive exam, the nurse tells a diabetic client about the necessity to undergo several tests to determine if the diabetes has caused complications. The nurse performs glucose testing, a foot exam, an ankle-brachial index, and checks the client's blood pressure. In addition to these tests, which type of exam should also be included to check for complications? A. Hearing test B. Abdominal palpation C. Injection site inspection D. Neck range of motion

C. A client who self-administers insulin on a regular basis can develop lipoatrophy, which is a loss of fat tissue. This can occur as an adverse effect from insulin, thought to occur when there are many injections into the subcutaneous tissue in one area. Another possible reason for lipoatrophy is insulin resistance.

A nurse is caring for a diabetic client who uses an insulin pump. The client is in the hospital for diagnostic testing of kidney disease and the provider has ordered an MRI. Which action of the nurse is most appropriate? A. Leave the insulin pump in place with the continued settings and check the client's glucose just before the MRI B. Remove the insulin pump four hours before the MRI and check the client's glucose just before the test C. Check the client's blood glucose and remove the insulin pump just before the MRI D. Leave the insulin pump in place but power it down and check the client's glucose levels just before the MRI

C. An insulin pump is a device that can provide insulin at a regular rate without requiring frequent injections. It is a small device about the size of a deck of cards and it sends insulin into a catheter under the skin. The pump is affected by strong magnetic fields, and so it must be taken off in some situations, such as with certain diagnostic tests. In this case, the nurse should remove the pump just before sending the client for an MRI.

Which of the following is an example of a rapid-acting type of insulin? A. Detemir B. Humulin N C. Lispro D. Novolin N

C. Insulin types have various rates of onset and peak times. Depending on the type of insulin used, the client needs to coordinate its administration with other activities that can cause a change in blood sugar. An example of a rapid-acting type insulin is Lispro.

The client is admitted with diabetes insipidus. What assessment data would indicate that client will receive Vasopressin? A. Urine specific gravity less than 1.000 B. Urine osmolarity of 210 mOsm/kg C. Heart rate of 72 beats/minute D. Blood pressure of 132/82

A. In diabetes insipidus (DI), the urine specific gravity decreases because the urine is diluted. Normal urine specific gravity is 1.000 -1.030.

The nurse is preparing to administer a sulfonylurea to a client. The nurse knows that this drug does which of the following? A. Fights infection by inhibiting cell wall synthesis B. Stimulates insulin secretion in beta cells C. Fights infection by inhibiting protein synthesis D. Stimulates aldosterone secretion in the adrenal cortex

B. A sulfonylurea is a drug that is given to regulate blood glucose by stimulating beta cells in the pancreas to secrete insulin.

A nurse is teaching a newly diagnosed diabetic client about controlling blood glucose levels with short-acting insulin. The nurse is teaching the client how to use an insulin syringe when the client complains "Why do I have to take an injection? Isn't there any way to take this insulin as a pill?" Which response from the nurse is accurate? A. Diabetes symptoms are more easily managed if you take injectable insulin instead of oral tablets B. Insulin cannot be taken as an oral tablet because stomach acid renders it ineffective C. Insulin is available as a tablet only in long-acting forms D. You cannot take insulin by mouth because the tablet would erode the lining of the esophagus

B. Although it would be an excellent option as an oral tablet, insulin has not yet been successfully created in this form. Insulin, when taken orally, breaks down in the stomach before it enters the liver to be utilized. The nurse in this situation must teach the client that insulin must be injected into the skin or infused intravenously to be effective.

The nurse is educating a client on a new prescription for a thiazolidinedione (TZD) to help control the client's blood glucose. The client asks how this medication works. Which response from the nurse is correct? A. This drug decreases the production of glucose in the liver B. This drug stimulates insulin secretion from the pancreas C. This drug helps improve cellular response to insulin D. This drug lowers the amount of glucose in the blood

C. A thiazolidinedione works by enhancing the sensitivity of insulin receptors at the cellular level.

Which drug or drug type would likely cause hyperglycemia if taken with glyburide? A. Procainamide B. Cimetidine C. Warfarin D. Thiazide diuretics

D. Hyperglycemia may occur if glyburide is taken with a thiazide diuretic.

The nurse is caring for a client who needs to have a CT with IV contrast but is allergic to IV contrast. Which medication needs to be given first? A. Simvastatin B. Diphenhydramine C. Prevastatin D. Methylprednisolone

D. In order to minimize the client's immune reaction, first this corticosteroid will be given over a period of time. Then, right before the CT, diphenhydramine is given.

A patient is being discharged from the hospital with a prescription for oral prednisone. Which of the following complications should the nurse counsel this client to look for while taking this drug? Select all that apply. A. Swelling B. Aggression and irritability C. Abdominal pain D. Hypertension E. Bleeding from the nose and ears

A, B, C, D - Prednisone has a number of uses that are beneficial for the patient and the drug may be used at home. However, the patient should be counseled about side effects to look for when taking this drug. Side effects to monitor for include an increase in patient aggression or irritability, as well as weight gain, swelling, and hypertension.

Which drug is typically prescribed for a patient with diabetes insipidus? A. ADH B. Oxytocin C. Pitocin D. Corticotropin

A. ADH is prescribed for hormone replacement therapy in a patient with neurogenic diabetes insipidus.

A nurse is caring for a client that has an order for an insulin drip STAT. What kind of insulin can be safely administered intravenously? A. NPH B. Determir C. Regular D. Glargine

C. For safe IV insulin administration, only short-acting insulins are appropriate. Regular insulin is short-acting and therefore safe to give intravenously.

A client with lupus has been using corticosteroids. Which of the following must the nurse consider if this client must undergo surgery? Select all that apply. A. The client is at risk of adrenal suppression B. The client may develop low blood pressure C. The client has an increased susceptibility to infection D. The client will most likely experience more pain E. The client may develop a spike in blood glucose levels

A, C, E - Corticosteroids are medications used for the management of various conditions as prescribed by the provider, including reducing inflammation in the client with lupus. If the client taking corticosteroids is undergoing surgery, the nurse must keep in mind potential complications. Corticosteroids reduce the body's ability to withstand stress due to adrenal atrophy. They also affect blood glucose levels and reduce the body's immune response to infection.

A nurse has just pulled glucagon from the medication room. The nurse could use this drug for which of the following purposes? Select all that apply. A. Stimulate the pancreas to release insulin B. Treat an unconscious diabetic with low glucose levels C. Treat insulin-induced hypoglycemia D. Provide nutrients to the brain and retina E. Treat hyperglycemia

B, C, D - Glucagon stimulates glycogenolysis in the liver, which will increase the client's blood glucose level within 5-20 minutes of administration. When the client is semi-conscious or unconscious and cannot ingest liquids, this is administered subcutaneously, intramuscularly or intravenously. Glucagon provides nutrients to the brain and retina, treats insulin-induced hypoglycemia and can be used on an unconscious hypoglycemic client. When the "glucose is gone", the client needs glucagon.

Which medications are most effective when administered just before a meal? Select all that apply. A. Insulin glargine B. Ibuprofen C. Pancrelipase D. Levothyroxine E. Insulin lispro

B, C, E - NSAIDs should be administered with food to prevent stomach upset, therefore administering these with a meal would be appropriate. Pancrelipase is an panreatic enzyme that helps with digestion of food and needs to be taken with food. Insulin lispro is a rapid acting insulin and therefore needs to be administered right before the client eats the meal to prevent hypoglycemia. Insulin glargine (Lantus) is a long acting insulin that is typically given at bedtime. Levothyroxine should be given on an empty stomach, therefore should be given at least an hour before a meal or two hours after.

The nurse has an order to given insulin to a client with acute renal failure. Which of the following is the purpose of giving insulin in this situation? A. To reduce hyperglycemia B. To move potassium out of cells C. To move potassium into cells D. To increase bloodstream sodium

C. Insulin administration in acute renal failure (ARF) helps to facilitate movement of potassium into the cells when potassium levels are dangerously high and dialysis is not immediately available. To prevent hypoglycemia for the client receiving insulin, IV glucose is also given.

An 88-year-old client presents to the emergency department after a fall and receives a head CT with contrast to rule out a brain hemorrhage. The nurse is reviewing the client's home medications and notes that the client takes metformin. The nurse would be most concerned if the client demonstrated which of the following signs and symptoms? A. Bradycardia and a blood glucose of 150 B. Dizziness and a blood pressure of 170/88 C. Abdominal cramps and a lactate of 5.5 mmol/L D. Angina and a troponin level of 0.05 ng/mL

C. These demonstrate lactic acidosis, which is an adverse effect of metformin therapy. The risk for lactic acidosis is greatly increased when a client on metformin receives iodine containing contrast, such as with a CT or other radiologic procedure. Lactic acidosis due to metformin use is a medical emergency. The nurse would hold any metformin dose, and the client would potentially need hemodialysis to correct the acidosis.

A nurse is assessing a diabetic client at the healthcare clinic who has a log of glucose levels and insulin dosages for the past month. The nurse notes that the client has had high levels of blood glucose every morning, requiring increased dosages of insulin first thing in the morning when compared to other times of day. Which of the following suggestions would most likely assist the client to have better readings of morning blood glucose levels? A. Adjust the insulin dose time from bedtime to dinnertime B. Ask the provider to add daily cortisol to the medication regimen C. Increase the amount of exercise per day D. Avoid carbohydrates near bedtime

D. This question describes the dawn phenomenon, which is a condition that occurs in some clients that is shown by increased levels of blood glucose when the client wakes up in the morning. This could occur from the body producing a surge of hormones between 2 and 8 am, insufficient insulin the night before, or carbohydrate consumption near bedtime. Regardless of the cause, glucose levels in the bloodstream rise, and the person awakes with higher-than-normal blood glucose levels. One way to improve morning glucose levels could be to avoid carbohydrates near bedtime.