A client has been hospitalized for multiple sclerosis exacerbation and is being given high dose IV glucocorticoid steroid medications. The prescriber places new orders for weight based sliding scale insulin. The patient asks why they need insulin. Are they now diabetic? What is the nurse's best response?

Choice A reason: This choice is incorrect because fluids should not be limited to 1000 mL daily for a client taking hydrochlorothiazide. Hydrochlorothiazide is a diuretic that causes the body to lose water and salt through urine. Limiting fluids can lead to dehydration, electrolyte imbalance, and kidney damage. The client should drink enough fluids to prevent thirst and dry mouth, and follow the doctor's advice on fluid intake.

Choice B reason: This choice is incorrect because this medication is not best taken at night for a client taking hydrochlorothiazide. Hydrochlorothiazide can cause frequent urination, which can disrupt the sleep cycle and cause fatigue. The client should take this medication in the morning or at least 4 hours before bedtime to avoid nocturia (nighttime urination).

Choice C reason: This choice is incorrect because dairy products should not be avoided while on this medication for a client taking hydrochlorothiazide. Hydrochlorothiazide can lower the level of calcium in the blood, which can cause muscle weakness, cramps, and osteoporosis. Dairy products are a good source of calcium and can help prevent calcium deficiency. The client should consume adequate amounts of calcium and vitamin D, and have their blood calcium level checked regularly.

Choice D reason: This choice is correct because the client should consume high potassium foods such as bananas and oranges while on this medication. Hydrochlorothiazide can lower the level of potassium in the blood, which can cause irregular heartbeat, muscle weakness, and numbness. Potassium-rich foods can help prevent potassium deficiency and maintain normal heart and muscle function. The client should also have their blood potassium level checked regularly and avoid salt substitutes that contain potassium.

Choice A reason: This choice is incorrect because glargine is not a drug that needs to be assessed before a CT scan with contrast. Glargine is a long-acting insulin that lowers blood sugar levels in people with diabetes. It is injected once a day, usually at bedtime, and works for 24 hours. The nurse should monitor the client's blood sugar levels and adjust the dose of glargine as needed, but it does not interfere with the CT scan or the contrast dye.

Choice B reason: This choice is correct because metformin is a drug that needs to be assessed before a CT scan with contrast. Metformin is an oral medication that lowers blood sugar levels in people with diabetes. It works by reducing the amount of glucose produced by the liver and increasing the sensitivity of the cells to insulin. However, metformin can cause a rare but serious condition called lactic acidosis, which is a buildup of lactic acid in the blood that can cause symptoms such as nausea, vomiting, abdominal pain, muscle weakness, and breathing problems. The risk of lactic acidosis is increased when metformin is combined with contrast dye, which can affect the kidney function and the clearance of metformin from the body. The nurse should check the client's kidney function and the dose and timing of metformin before the CT scan. The nurse should also instruct the client to stop taking metformin before and after the CT scan, as directed by the provider.

Choice C reason: This choice is incorrect because famotidine is not a drug that needs to be assessed before a CT scan with contrast. Famotidine is an antacid that reduces the amount of acid in the stomach. It is used to treat conditions such as gastroesophageal reflux disease (GERD), ulcers, and gastritis. It does not affect the blood sugar levels or the kidney function, and it does not interact with the contrast dye. The nurse should administer famotidine as prescribed and monitor the client's gastrointestinal symptoms, but it does not require any special precautions before the CT scan.

Choice D reason: This choice is incorrect because glucagon is not a drug that needs to be assessed before a CT scan with contrast. Glucagon is a hormone that raises blood sugar levels in people with diabetes. It is used as an emergency treatment for severe hypoglycemia (low blood sugar), when the person is unconscious or unable to swallow. It is injected into a muscle or under the skin, and it works by stimulating the liver to release glucose into the blood. The nurse should have glucagon available in case of hypoglycemia, but it does not affect the CT scan or the contrast dye.