A client diagnosed with type 2 diabetes will begin taking metformin (Glucophage). The nurse understands that the client is at risk for which serious condition(s) when taking metformin (Glucophage)?
Respiratory distress
Seizures
Lactic acidosis and renal failure
Hyperglycemia
The Correct Answer is C
Choice A rationale:
Respiratory distress is not a direct side effect of metformin. While metformin can cause a rare condition called lactic acidosis, which can lead to rapid breathing, respiratory distress is not a primary concern with metformin use.
Respiratory distress typically involves difficulty breathing due to other causes such as asthma, pneumonia, heart failure, or chronic obstructive pulmonary disease (COPD).
Choice B rationale:
Seizures are not a known side effect of metformin.
Seizures are typically associated with neurological conditions, such as epilepsy, or metabolic disturbances such as hypoglycemia or electrolyte imbalances.
Metformin does not directly affect the central nervous system in a way that would increase the risk of seizures.
Choice C rationale:
Lactic acidosis:
This is a rare but serious condition that can occur with metformin use.
It happens when lactic acid builds up in the bloodstream, causing the blood to become too acidic. Symptoms of lactic acidosis include:
Rapid breathing Nausea and vomiting Abdominal pain Muscle weakness Unusual sleepiness Feeling cold
Risk factors for lactic acidosis in patients taking metformin include:
Kidney disease Congestive heart failure Liver disease Dehydration
Excessive alcohol intake Recent surgery or heart attack
It's important to note that lactic acidosis is rare, occurring in about 3 to 10 cases per 100,000 people taking metformin per year.
Renal failure:
Metformin is primarily eliminated by the kidneys.
If kidney function is impaired, metformin can build up in the body, increasing the risk of lactic acidosis. Additionally, metformin can potentially cause kidney damage in rare cases, further worsening kidney function. It's crucial to monitor kidney function regularly in patients taking metformin.
Choice D rationale:
Hyperglycemia (high blood sugar) is not a side effect of metformin.
In fact, metformin is a medication used to lower blood sugar levels in people with type 2 diabetes. It works by:
Decreasing the amount of glucose produced by the liver Improving the body's sensitivity to insulin
Slowing the absorption of glucose from the intestines
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A Rationale:
NPH insulin can be mixed with certain other insulins, such as regular insulin, to achieve different effects and better control blood glucose levels. Therefore, stating that it should never be mixed with another insulin is incorrect.
Choice C rationale:
NPH insulin is an intermediate-acting insulin that can be administered at various times of the day, depending on the individual's needs and blood glucose patterns. It is not restricted to bedtime administration only.
Choice D rationale:
When mixing NPH insulin with another insulin, the order of mixing does not significantly affect its action. The crucial aspect is to ensure proper mixing of the insulins before administration.
Choice B rationale:
NPH insulin is a suspension, meaning the insulin particles are not fully dissolved in the liquid. Therefore, it's essential to roll the vial gently between the palms to evenly distribute the insulin particles throughout the solution. This ensures that the patient receives the correct dose and prevents injection of an uneven mixture, which could lead to unpredictable blood glucose levels.
Key points to remember:
NPH insulin is an intermediate-acting insulin that starts working within 1 to 2 hours, peaks in 4 to 12 hours, and lasts for 12 to 18 hours.
It can be mixed with regular insulin to provide both short-acting and longer-acting insulin coverage. Always follow the specific instructions provided by the insulin manufacturer and healthcare provider. Proper mixing of NPH insulin is crucial for accurate dosing and optimal glucose control.
Correct Answer is C
Explanation
Rationale for Choice A:
Decreasing the morning insulin dose by half without consulting the provider could lead to hyperglycemia, which can be dangerous for patients with diabetes, especially those undergoing surgery.
It is important to individualize insulin doses based on the patient's blood glucose levels, insulin sensitivity, and other factors. The provider may need to assess the patient's blood glucose levels and adjust the insulin dose accordingly.
Rationale for Choice B:
It is not safe to assume that the provider would want the client to receive the usual insulin dose prior to surgery without confirming this with the provider.
Patients with diabetes who are NPO (nothing by mouth) are at risk for hypoglycemia, as they are not receiving their usual intake of carbohydrates.
It is important to adjust insulin doses to prevent hypoglycemia in these patients.
Rationale for Choice D:
Holding the morning dose of insulin until after a fasting glucose is done could lead to hyperglycemia, as the patient would not be receiving any insulin to cover their blood glucose levels.
It is important to administer insulin to patients with diabetes, even if they are NPO, to prevent hyperglycemia.
Rationale for Choice C:
This is the best action for the nurse to take because it ensures that the provider is aware of the situation and can provide appropriate orders for the patient's insulin management.
The provider may need to adjust the insulin dose, order a fasting glucose level, or provide other instructions for the patient's care.
It is important to communicate with the provider to ensure that the patient receives safe and appropriate care.
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