Diabetes Meds
A client with a history of coronary artery disease has developed diabetes insipidus as a result of cranial surgery. The client's medication therapy will include vasopressin (Pitressin). The nurse monitors this client most carefully for which sign/symptom that indicates an adverse effect of this medication? 1. Depression 2. Chest pain 3. Joint stiffness 4. Nagging cough
2. Chest pain
A client newly diagnosed with diabetes mellitus is instructed by the health care provider to obtain glucagon for emergency home use. The client asks the home care nurse about the purpose of the medication. The nurse should instruct the client that the purpose of the medication is to treat which problem? 1. Lipoatrophy from insulin injections 2. Hypoglycemia from insulin overdose 3. Hyperglycemia from insufficient insulin 4. Lipohypertrophy from inadequate insulin absorption
2. Hypoglycemia from insulin overdose
A client received 20 units of Humulin N insulin subcutaneously at 08:00. At what time should the nurse plan to assess the client for a hypoglycemic reaction? 1. 10:00 2. 11:00 3. 17:00 4. 23:00
3. 17:00
A client with previously well-controlled diabetes mellitus has had fasting blood glucose levels ranging from 180 to 200 mg/dL. The client takes glyburide (Diabeta) 5 mg orally daily. In reviewing the client's medication list, the home health care nurse suspects that which newly added medications could be contributing to the elevated blood glucose levels? 1. Prednisone 2. Ranitidine (Zantac) 3. Ciprofloxacin (Cipro) 4. Cimetidine (Tagamet)
1. Prednisone
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.
2. Refrigerate the insulin.
The diabetes nurse specialist conducts a teaching session to a group of nursing students regarding sulfonylureas, oral hypoglycemic medications used for type 2 diabetes mellitus. Which statement, describing the primary action of these medications, should the nurse include in the teaching session? 1. "Sulfonylureas decrease insulin resistance." 2. "Sulfonylureas inhibit carbohydrate digestion." 3. "Sulfonylureas decrease glucose production by the liver." 4. "Sulfonylureas promote insulin secretion by the pancreas."
4. "Sulfonylureas promote insulin secretion by the pancreas."
A nurse is providing teaching regarding acarbose (Precose). The nurse should tell that client that which expected side effect(s) may occur with this medication? 1. Tachycardia 2. Hypoglycemia 3. Tinnitus and decreased hearing 4. Abdominal distention and diarrhea
4. Abdominal distention and diarrhea
Metformin (Glucophage) is prescribed for a client with type 2 diabetes mellitus. The nurse should tell the client that which is the mostcommon side effect of the medication? 1. Weight gain 2. Hypoglycemia 3. Flushing and palpitations 4. Gastrointestinal (GI) disturbances
4. Gastrointestinal (GI) disturbances
Lispro insulin (Humalog) is prescribed for the client, and the client is instructed to administer the insulin before meals. When should the nurse instruct the client to administer the insulin? 1. 45 minutes before eating 2. 60 minutes before eating 3. 90 minutes before eating 4. Immediately before eating
4. Immediately before eating
The clinic nurse develops a plan of care for a client with emphysema who will be started on long-term corticosteroid therapy. Which specific instruction should the nurse include in the plan of care? 1. Instruct the client to maintain a low-potassium diet. 2. Encourage the client to consume a fluid intake of 3000 mL/day. 3. Encourage the client to increase the amounts of sodium intake in the diet. 4. Instruct the client to return to the clinic for monitoring of blood glucose levels.
4. Instruct the client to return to the clinic for monitoring of blood glucose levels.
A client must learn how to mix Humulin R and Humulin N insulin in the same syringe. The nurse should include which teaching point in the instructions to the client? 1. Keep both bottles in the refrigerator at all times. 2. Take all of the air out of the bottle before mixing. 3. Draw up the Humulin N insulin into the syringe first. 4. Rotate the Humulin N insulin bottle in the hands before mixing.
4. Rotate the Humulin N insulin bottle in the hands before mixing.
A nurse is caring for a client recently diagnosed with type 2 diabetes mellitus who has been prescribed glipizide (Glucotrol XL). What is the most important point for the nurse to include in teaching this client about this medication? 1. Take the medication at least 1 hour after eating. 2. Make sure to take the medication every 12 hours. 3. Take measures to prevent and treat hyperglycemia. 4. Swallow the medication whole and never crush or chew it.
4. Swallow the medication whole and never crush or chew it.
The nurse administers 20 units of Humulin N insulin to a hospitalized client with diabetes mellitus at 7:00 am. The nurse should monitor the client most closely for a hypoglycemic reaction at which time? 1. 4:00 pm 2. 9:00 am 3. 10:00 am 4. 12:00 midnight
1. 4:00 pm
The nurse monitors the blood glucose level of the client who received Humulin N insulin at 7 am with an understanding that the client may experience a hypoglycemic reaction during which time frame? 1. 9 am to 11 am 2. 11 am to 7 pm 3. 7 pm to 11 pm 4. Midnight to 6 am
2. 11 am to 7 pm
The nurse evaluates that the family of a client newly diagnosed with diabetes mellitus correctly understands the reason for having glucagon on hand for emergency home use if the family indicates that the purpose of the medication is to treat which complication? 1. Diabetic ketoacidosis 2. Hypoglycemia from insulin overdose 3. Hyperglycemia from insufficient insulin 4. Hyperglycemia occurring on "sick days"
2. Hypoglycemia from insulin overdose
A nurse is providing teaching regarding nateglinide (Starlix). A portion of the teaching involves time of administration, and the nurse should tell the client to take the medication at which time? 1. Bedtime 2. During lunch 3. During breakfast 4. Before each meal
4. Before each meal
The nurse is preparing the client's morning Humulin N insulin dose. The nurse notices a clumpy precipitate inside the insulin vial. What is the most appropriate nursing action related to this finding? 1. Draw the dose from a new vial. 2. Draw up and administer the dose. 3. Shake the vial in an attempt to disperse the clump. 4. Warm the bottle under running water to dissolve the clump.
1. Draw the dose from a new vial.
Vasopressin (Pitressin) is prescribed for a client with diabetes insipidus. The nurse should be particularly cautious in monitoring a client receiving this medication if the client has which preexisting condition? 1. Depression 2. Endometriosis 3. Pheochromocytoma 4. Coronary artery disease
4. Coronary artery disease
Glimepiride (Amaryl) is prescribed for a client with diabetes mellitus. The nurse instructs the client to avoid consuming which food while taking this medication? 1. Alcohol 2. Organ meats 3. Whole-grain cereals 4. Carbonated beverages
1. Alcohol
The nurse is preparing to administer an intravenous (IV) insulin injection. The vial of Regular insulin has been refrigerated. On inspection of the vial, the nurse finds that the medication is frozen. Which should the nurse do? 1. Discard the insulin and obtain another vial. 2. Wait for the insulin to thaw at room temperature. 3. Check the temperature settings of the refrigerator. 4. Rotate the vial between the hands until the medication becomes liquid.
1. Discard the insulin and obtain another vial.
The nurse is preparing a dose of 10 units of Humulin R and 35 units of Humulin N insulin for a client with type 1 diabetes mellitus. The nurse obtains an insulin syringe, gently rotates the insulin solutions, cleanses the tops of the vials of insulin, and injects an amount of air equal to the dose prescribed into each vial. What is the next nursing action? 1. Draws up 10 units of Humulin R and checks the syringe contents with another nurse before drawing up the Humulin N insulin 2. Draws up 10 units of Humulin R, draws up 35 units of Humulin N insulin, and checks the syringe contents with another nurse 3. Draws up 35 units of Humulin N insulin and checks the syringe contents with another nurse before drawing up the Humulin R 4. Draws up 35 units of Humulin N insulin, draws up 10 units of Humulin R, and checks the syringe contents with another nurse
1. Draws up 10 units of Humulin R and checks the syringe contents with another nurse before drawing up the Humulin N insulin
The nurse understands that which is the action of rosiglitazone (Avandia)? 1. Reduces insulin resistance. 2. Increases glucose secretion. 3. Delays absorption of dietary carbohydrates. 4. Increases insulin release from the pancreas.
1. Reduces insulin resistance.
A client who has sustained an eye injury has been prescribed prednisolone. The nurse would most carefully monitor for side/adverse effects of this medication if the client has which health problem listed on the medical record? 1. Cirrhosis 2. Hypertension 3. Diabetes mellitus 4. Chronic constipation
3. Diabetes mellitus
A nurse caring for a 23-year-old client newly diagnosed with type 1 diabetes mellitus teaches the client insulin administration. Which statement by the client indicates a need for further teaching? 1. "It is not necessary for me to aspirate before injecting my insulin." 2. "I will rotate my insulin injection between my arms, thighs, and abdomen on a daily basis." 3. "I will perform a capillary blood glucose measurement before I administer my insulin regimen." 4. "My glargine insulin is long-acting and should be administered once a day, but lispro insulin is given just before I eat."
2. "I will rotate my insulin injection between my arms, thighs, and abdomen on a daily basis."
Metformin (Glucophage) is prescribed for a client with type 2 diabetes mellitus. What is the most common side effect that the nurse should include in the client's teaching plan? 1. Weight gain 2. Hypoglycemia 3. Flushing and palpitations 4. Gastrointestinal disturbances
4. Gastrointestinal disturbances
The nurse teaches a client newly diagnosed with type 1 diabetes about storing Humulin N insulin. Which statement indicates to the nurse that the client understood the discharge teaching? 1. "I should keep the insulin in the cabinet during the day only." 2. "I know I have to keep my insulin in the refrigerator at all times." 3. "I can store the open insulin bottle in the kitchen cabinet for 1 month." 4. "The best place for my insulin is on the window sill, but in the cupboard is just as good."
3. "I can store the open insulin bottle in the kitchen cabinet for 1 month."
A client with diabetes mellitus calls the clinic and tells the nurse that he has been nauseated during the night. The client asks the nurse if the morning insulin should be administered. Which is the most appropriate nursing response? 1. Omit the insulin. 2. Administer half the prescribed dose. 3. Administer the full dose as prescribed. 4. Wait until noon before making a decision.
3. Administer the full dose as prescribed.
The health care provider has prescribed Humulin R insulin 6 units and Humulin N insulin 20 units subcutaneously to be administered every morning. How should the nurse prepare to administer insulin? 1. Shaking the Humulin N insulin vial to distribute the suspension 2. Administering Humulin R and Humulin N insulin in separate syringes 3. Drawing up the Humulin R first and then the Humulin N insulin in the same syringe 4. Drawing up the Humulin N insulin first and then the Humulin R in the same syringe
3. Drawing up the Humulin R first and then the Humulin N insulin in the same syringe
The nurse is preparing to care for a client admitted to the emergency department with a diagnosis of diabetic ketoacidosis (DKA). The nurse gathers supplies and obtains which type of insulin, anticipating that it will be initially prescribed for the client? (image: insulin-label.jpg) 1. A 2. B 3. C 4. D
1. A
The nurse is monitoring a client receiving glipizide (Glucotrol). The nurse knows that which finding would indicate a therapeutic outcome for this client? 1. A decrease in polyuria 2. An increase in appetite 3. A glycosylated hemoglobin of 10% 4. A fasting blood glucose of 220 mg/dL
1. A decrease in polyuria
Insulin glargine (Lantus) is prescribed for a client with diabetes mellitus. The nurse should tell the client that it is best to take the insulin at which time? 1. At bedtime 2. 1 hour after each meal 3. 15 minutes before the morning and evening meal 4. Before each meal, on the basis of the blood glucose level
1. At bedtime
The home health care nurse is visiting a client who was recently diagnosed with type 2 diabetes mellitus. The client is prescribed repaglinide (Prandin) and metformin (Glucophage) and asks the nurse to explain these medications. 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. Metformin increases hepatic glucose production to prevent hypoglycemia associated with repaglinide. 6.Muscle pain is an expected effect of metformin and may be treated with acetaminophen (Tylenol).
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.
A client 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.
1. Hypoglycemia may be experienced before dinnertime. 3.The insulin should be administered at room temperature.
A client with diabetes mellitus visits a health care clinic. The client's diabetes mellitus previously had been well controlled with glyburide (DiaBeta) daily, but recently the fasting blood glucose level has been 180 to 200 mg/dL. Which medication, if added to the client's regimen, may have contributed to the hyperglycemia? 1. Prednisone 2. Phenelzine (Nardil) 3. Atenolol (Tenormin) 4. Allopurinol (Zyloprim)
1. Prednisone
An 8-year-old boy is being treated with desmopressin (DDAVP). Understanding the purpose of this medication, the nurse should set which client goal? 1. The boy will have 5 nights in sequence without enuresis. 2. The boy will have increased urine output to 2400 mL per day. 3. The boy will have an increase in white blood cell count to 4000 cells/mm3. 4. The boy will have decreased use of the metered dose inhaler to three times per week.
1. The boy will have 5 nights in sequence without enuresis.
The nurse is teaching a client 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
1. Withdraws the NPH insulin first
The health care provider (HCP) prescribes exenatide (Byetta) 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 HCP, questioning the prescription for the client. 2. Administer the medication within 60 minutes before the morning and evening meal. 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.
1. Withhold the medication and call the HCP, questioning the prescription for the client.
A client with diabetes mellitus is self-administering Humulin N insulin from a vial that is kept at room temperature. The client asks the nurse about the length of time an unrefrigerated vial of insulin will maintain its potency. What is the most appropriate response to the client? 1. 2 weeks 2. 1 month 3. 2 months 4. 6 months
2. 1 month
A hospitalized client with diabetes mellitus receives Humulin N insulin in the morning. The nurse monitors the client for hypoglycemia, knowing that the peak action is expected to occur how soon after the medication administration? 1. 2 to 4 hours after administration 2. 4 to 12 hours after administration 3. 12 to 16 hours after administration 4. 18 to 24 hours after administration
2. 4 to 12 hours after administration
A client with diabetes mellitus taking daily Humulin N insulin has been started on therapy with dexamethasone (Decadron). The nurse anticipates that which adjustments in medication dosage will be made? 1. A change to oral diabetic medications 2. An increased dose of Humulin N insulin 3. An increase in the amount of daily dietary calories 4. A lower dose of dexamethasone (Decadron) than usual
2. An increased dose of Humulin N insulin
A sulfonamide is prescribed for a client with a urinary tract infection. The client has diabetes mellitus and is receiving tolbutamide (Orinase). Because the client will be taking these two medications, which prescription should the nurse anticipate for this client? 1. Increased dosage of tolbutamide 2. Decreased dosage of tolbutamide 3. Increased dosage of sulfonamide 4. Decreased dosage of sulfonamide
2. Decreased dosage of tolbutamide
The nurse in the health care clinic is reviewing the record of a client with diabetes mellitus who was just seen by the health care provider (HCP). The nurse notes that the HCP has prescribed metformin (Glucophage). What preexisting disorder, if noted in the client's record, would indicate a need to collaborate with the HCP before instructing the client to take the medication? 1. Foot ulcer 2. Emphysema 3. Hypertension 4. Hypothyroidism
2. Emphysema
A client is seen in the clinic for complaints of thirst, frequent urination, and headaches. After diagnostic studies, diabetes insipidus is diagnosed. Desmopressin (DDAVP) is prescribed. The client asks why this medication was prescribed. Which is a correct statement by the nurse? 1. It relieves the headaches. 2. It increases water reabsorption. 3. It stimulates the production of aldosterone. 4. It decreases the production of the antidiuretic hormone.
2. It increases water reabsorption.
The emergency department nurse is caring for a client admitted with diabetic ketoacidosis. The health care provider prescribes intravenous (IV) insulin. The nurse plans to prepare which type of insulin for the client? 1. Insulin glargine (Lantus) 2. Regular humulin (Humulin R) 3. Isophane insulin NPH (Humulin N) 4. 50% human insulin isophane/50% human insulin (Humulin 50/50)
2. Regular humulin (Humulin R)
Glyburide (DiaBeta) daily is prescribed for a client. What instruction will the nurse include in the client's teaching plan? 1. The medication is used to prevent foot infections. 2. Take the medication in the morning before breakfast. 3. Expect skin color change from pink to yellow and also pale-colored stools. 4. Contact the health care provider (HCP) immediately if an altered taste sensation is noted
2. Take the medication in the morning before breakfast.
Acarbose (Precose) is prescribed to treat a client with type 2 diabetes mellitus. Which instruction should the nurse provide when teaching the client about this medication? 1. Take the medication at bedtime. 2. Take the medication with the first bite of each regular meal. 3. The medication will be used to treat symptoms of hypoglycemia. 4. Headache and dizziness are the most common side effects of this medication.
2. Take the medication with the first bite of each regular meal.
A client newly diagnosed with diabetes mellitus is instructed by the health care provider to obtain glucagon for emergency home use. The client asks a home care nurse about the purpose of the medication. What is the nurse's best response to the client's question? 1. "It will boost the cells in your pancreas if you have insufficient insulin." 2. "It will help promote insulin absorption when your glucose levels are high." 3. "It is for the times when your blood glucose is too low from too much insulin." 4. "It will help prevent lipoatrophy from the multiple insulin injections over the years."
3. "It is for the times when your blood glucose is too low from too much insulin."
Prednisone is prescribed for a client with diabetes mellitus who is taking Humulin NPH insulin daily. Which prescription change does the nurse anticipate during therapy with the prednisone? 1. An additional dose of prednisone daily 2. A decreased amount of daily Humulin NPH insulin 3. An increased amount of daily Humulin NPH insulin 4. The addition of an oral hypoglycemic medication daily
3. An increased amount of daily Humulin NPH insulin
The nurse understands that which is an advantage of insulin glargine (Lantus) over other extended-release insulins? 1. Has a distinct peak 2. Can be administered intravenously 3. Carries a decreased risk of hypoglycemia 4. Does not require finger-stick glucose monitoring
3. Carries a decreased risk of hypoglycemia
A client is started on tolbutamide (Orinase) once daily. The nurse should instruct the client to monitor for which intended effect of this medication? 1. Weight loss 2. Resolution of infection 3. Decreased blood glucose 4. Decreased blood pressure
3. Decreased blood glucose
A client with diabetes insipidus asks the nurse about the purpose of a new medication, vasopressin (Pitressin). The nurse explains that this medication works by which mechanism? 1. Decreasing peristalsis 2. Producing vasodilation 3. Decreasing urinary output 4. Inhibiting contraction of smooth muscle
3. Decreasing urinary output
The client with a head injury has begun excreting copious amounts of dilute urine through the Foley catheter. The client's urine output for the previous shift was 3000 mL. The nurse expects that the health care provider will prescribe which medication? 1. Dexamethasone 2. Mannitol (Osmitrol) 3. Desmopressin (DDAVP) 4. Ethacrynic acid (Edecrin)
3. Desmopressin (DDAVP)
The nurse is completing a health history for an insulin dependent client who has been self-administering insulin for 40 years. The client reports experiencing periods of hypoglycemia followed by periods of hyperglycemia. What is the most likely cause for this pattern of blood glucose fluctuation? 1. Eating snacks between meals 2. Initiating the use of the insulin pump 3. Injecting insulin at a site of lipodystrophy 4. Adjusting insulin according to blood glucose levels
3. Injecting insulin at a site of lipodystrophy
A nurse is administering a prescribed dose of dexamethasone (Decadron) to a client following cranial surgery. Which would the nurse implement to assess for a common side effect of this medication? 1. Monitor for hair loss. 2. Assess for decreased skin turgor. 3. Perform blood glucose monitoring. 4. Monitor laboratory test results for hyperkalemia.
3. Perform blood glucose monitoring.
The nurse is instructing a client regarding intranasal desmopressin (DDAVP). The nurse should tell the client that which occurrence is a side effect of the medication? 1. Headache 2. Vulval pain 3. Runny nose 4. Flushed skin
3. Runny nose
Why is controlling blood glucose levels important? A. High blood glucose levels increase the risk for heart disease, strokes, blindness, and kidney failure. B. High blood glucose levels increase the risk for seizure disorders, arthritis, osteoporosis, and bone fractures. C. Low blood glucose levels increase the risk for peripheral neuropathy, Alzheimer's disease, and premature aging. D. Low blood glucose levels increase the risk for obesity, pancreatitis, dehydration, and certain types of cancer.
A. High blood glucose levels increase the risk for heart disease, strokes, blindness, and kidney failure. Rationale Persistent high blood glucose levels cause major changes in blood vessels that lead to organ damage, serious health problems, and early death. The long-term complications of diabetes include heart attacks, strokes, and kidney failure. In addition, diabetes is the main cause of foot and leg amputations and new-onset blindness.
Which statement made by the client during nutritional counseling indicates to the nurse that the client with diabetes type 1 correctly understands his or her nutritional needs? A. "If I completely eliminate carbohydrates from my diet, I will not need to take insulin." B. "I will make certain that I eat at least 130 g of carbohydrate each day regardless of my activity level." C. "My intake of protein in terms of grams and calories should be the same as my intake of carbohydrate." D. "My intake of unsaturated fats in terms of grams and calories should be the same as my intake of protein."
B. "I will make certain that I eat at least 130 g of carbohydrate each day regardless of my activity level." Rationale Carbohydrates are the main fuel for the human cellular engine and the substance most commonly used to make ATP. Clients who have diabetes should never consume less than 130 g of carbohydrate per day (the percentage of total calories needed is determined for each client). Protein intake should range between 15% and 30% of total caloric intake per day.
The client newly diagnosed with type 1 diabetes asks why insulin is given only by injection and not as an oral drug. What is the nurse's best response? A. "Injected insulin works faster than oral drugs to lower blood glucose levels." B. "Oral insulin is so weak that it would require very high dosages to be effective." C. "Insulin is a small protein that is destroyed by stomach acids and intestinal enzymes." D. "Insulin is a "high alert drug" and could more easily be abused if it were available as an oral agent."
C. "Insulin is a small protein that is destroyed by stomach acids and intestinal enzymes." Rationale Because insulin is a small protein that is easily destroyed by stomach acids and intestinal enzymes, it cannot be used as an oral drug. Most commonly, it is injected subcutaneously.
The client newly diagnosed with diabetes asks why he is always so thirsty. What is the nurse's best response? A. "The extra glucose in the blood increases the blood sodium level, which increases your sense of thirst." B. "Without insulin, glucose is excreted rather than used in the cells. The loss of glucose directly triggers thirst, especially for sugared drinks." C. "The extra glucose in the blood makes the blood thicker, which then triggers thirst so that the water you drink will dilute the blood glucose level." D. "Without insulin, glucose combines with blood cholesterol, which damages the kidneys, making you feel thirsty even when no water has been lost."
C. "The extra glucose in the blood makes the blood thicker, which then triggers thirst so that the water you drink will dilute the blood glucose level." Rationale: The movement of glucose into cells is impaired, and the resulting high blood glucose levels increase the osmolarity of the blood. This increased osmolarity stimulates the osmoreceptors in the hypothalamus, triggering the thirst reflex. In response, the person drinks more water (not sugary fluids or hyperosmotic fluids), which helps dilute blood glucose levels and reduces blood osmolarity.
A client with type 2 diabetes who also has heart failure is prescribed metformin extended-release (Glucophage XR) once daily. On assessment, the nurse finds that the client now has muscle aches, drowsiness, low blood pressure, and a slow, irregular heartbeat. What is the nurse's best action? A. Assess the client's blood glucose level and prepare to administer IV glucose. B. Reassure the client that these symptoms are normal effects of this drug. C. Hold the dose and notify the prescriber immediately. D. Administer the drug at bedtime to prevent falls.
C. Hold the dose and notify the prescriber immediately. Rationale Muscle aches, drowsiness, low blood pressure, and a slow irregular heartbeat are symptoms of lactic acidosis, an adverse reaction to metformin. The drug should be stopped and the prescriber notified so steps can be taken to reduce the client's acidosis.