A client with diabetes is scheduled for a CT scan of the abdomen with oral and IV contrast. Which medication would be of concern?
Insulin glargine (Lantus)
Acarbose (Precose)
Metformin (Glucophage)
Glipizide (Glucotrol)
The Correct Answer is C
Choice A rationale:
Insulin glargine (Lantus) is a long-acting insulin that does not have any immediate effect on blood glucose levels. It is not typically a concern for patients undergoing CT scans with contrast.
However, it is important to monitor blood glucose levels closely in patients with diabetes who are receiving insulin therapy, as the contrast media used in CT scans can sometimes cause hyperglycemia.
Choice B rationale:
Acarbose (Precose) is an alpha-glucosidase inhibitor that works by slowing the absorption of carbohydrates from the intestines. This can help to reduce blood glucose levels after meals.
Acarbose is not typically a concern for patients undergoing CT scans with contrast. However, it is important to note that acarbose can sometimes cause gastrointestinal side effects, such as bloating, gas, and diarrhea. These side effects may be worsened by the contrast media used in CT scans.
Choice C rationale:
Metformin (Glucophage) is a biguanide that works by reducing glucose production in the liver and increasing insulin sensitivity in the muscles. It is a commonly used medication for the treatment of type 2 diabetes.
Metformin is a concern for patients undergoing CT scans with contrast because it can increase the risk of lactic acidosis. Lactic acidosis is a serious condition that can occur when there is a buildup of lactic acid in the blood. It can be caused by metformin, as well as by other factors such as dehydration, kidney problems, and liver problems.
The contrast media used in CT scans can also increase the risk of lactic acidosis. This is because the contrast media can sometimes cause kidney damage, which can impair the body's ability to remove lactic acid from the blood.
For this reason, metformin is typically discontinued for 48 hours before a CT scan with contrast. It is also important to ensure that patients are well-hydrated before and after the scan.
Choice D rationale:
Glipizide (Glucotrol) is a sulfonylurea that works by stimulating the release of insulin from the pancreas. It is a commonly used medication for the treatment of type 2 diabetes.
Glipizide is not typically a concern for patients undergoing CT scans with contrast. However, it is important to monitor blood glucose levels closely in patients with diabetes who are receiving sulfonylurea therapy, as the contrast media used in CT scans can sometimes cause hypoglycemia.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","D"]
Explanation
Rationale for Choice A: Nitroglycerin IV gtt, titrate for SBP > 180mmHg
Mechanism of action: Nitroglycerin is a potent vasodilator that acts primarily on veins, but also has some arterial vasodilatory effects. It relaxes vascular smooth muscle by stimulating the production of nitric oxide, which causes vasodilation. This decrease in preload (venous return to the heart) and afterload (resistance against which the heart pumps) leads to a reduction in blood pressure.
Indications: Nitroglycerin is a preferred agent for hypertensive emergencies associated with acute heart failure, acute coronary syndromes, and aortic dissection. It is also effective in hypertensive emergencies with elevated intracranial pressure.
Dosage and administration: Nitroglycerin is typically administered as an intravenous infusion, starting at a low dose and titrating up based on blood pressure response. The goal is to titrate the medication to maintain systolic blood pressure below 180 mmHg.
Contraindications: Nitroglycerin is contraindicated in patients with a known hypersensitivity to nitrates, severe hypotension (systolic blood pressure < 90 mmHg), or those who have recently used phosphodiesterase-5 inhibitors (such as sildenafil).
Monitoring: During nitroglycerin infusion, it's essential to monitor blood pressure closely, as well as heart rate, for any signs of hypotension or tachycardia.
Rationale for Choice B: Labetalol (Normodyne) 10mg IVP q 10 minutes prn for SBP >170 mmHg
Mechanism of action: Labetalol is a mixed alpha- and beta-adrenergic blocker. It blocks the effects of norepinephrine and epinephrine, leading to vasodilation and a decrease in heart rate.
Indications: Labetalol is a versatile agent that can be used in various hypertensive emergencies, including those associated with acute aortic dissection, acute coronary syndromes, and pre-eclampsia/eclampsia. It's also useful in patients with a history of asthma or chronic obstructive pulmonary disease (COPD), as it has less bronchoconstrictive effects than beta-blockers like propranolol.
Dosage and administration: Labetalol can be administered as an intravenous bolus or infusion. In this scenario, it's prescribed as a 10mg intravenous push every 10 minutes as needed for systolic blood pressure greater than 170 mmHg.
Contraindications: Labetalol is contraindicated in patients with severe bradycardia, heart block, cardiogenic shock, or decompensated heart failure.
Monitoring: During labetalol administration, it's important to monitor blood pressure, heart rate, and electrocardiogram (ECG) for any signs of bradycardia, heart block, or other arrythmias.
Rationale for Choice D: Nitroprusside (Nitropress) IV gtt titrate to keep SBP < 160 mmHg
Mechanism of action: Nitroprusside is a potent vasodilator that acts directly on both arterioles and veins. It relaxes vascular smooth muscle by releasing nitric oxide, leading to a rapid and profound decrease in blood pressure.
Indications: Nitroprusside is often reserved for hypertensive emergencies that are refractory to other agents or those that require rapid blood pressure control, such as hypertensive encephalopathy or acute aortic dissection.
Dosage and administration: Nitroprusside is administered as an intravenous infusion and titrated to the desired blood pressure response. The goal is to keep systolic blood pressure below 160 mmHg.
Contraindications: Nitroprusside is contraindicated in patients with severe renal impairment or those with increased intracranial pressure.
Monitoring: Nitroprusside therapy requires close monitoring of blood pressure, as well as monitoring for thiocyanate toxicity (a metabolite of nitroprusside) in patients with prolonged infusion or renal impairment.
Correct Answer is B
Explanation
Choice A rationale:
Dopamine is a catecholamine that acts on both alpha- and beta-adrenergic receptors. It has inotropic (increases heart contractility), chronotropic (increases heart rate), and vasopressor (constricts blood vessels) effects.
It was previously used as a first-line agent for cardiogenic shock, but it has fallen out of favor due to concerns about its potential to increase heart rate and arrhythmias, which can worsen myocardial oxygen demand and ischemia.
Additionally, dopamine's effects on renal blood flow can be unpredictable, and it may not be as effective as norepinephrine in increasing blood pressure in patients with severe shock.
Choice B rationale:
Norepinephrine is a potent alpha-adrenergic agonist that causes vasoconstriction, leading to an increase in blood pressure. It has minimal beta-adrenergic effects, so it does not significantly increase heart rate.
Norepinephrine is the preferred first-line vasopressor for cardiogenic shock because it effectively raises blood pressure without significantly increasing heart rate or myocardial oxygen demand.
It also has beneficial effects on renal blood flow and may improve organ perfusion.
Choice C rationale:
Epinephrine is a potent alpha- and beta-adrenergic agonist. It has strong inotropic, chronotropic, and vasopressor effects.
It can be used in cardiogenic shock, but it is typically reserved for patients who do not respond adequately to norepinephrine or who have severe bradycardia.
Epinephrine's potent beta-adrenergic effects can increase heart rate and myocardial oxygen demand, which can be detrimental in patients with cardiogenic shock.
Choice D rationale:
Vasopressin (Pitressin) is a hormone that acts on V1 receptors in vascular smooth muscle to cause vasoconstriction. It is not a first-line agent for cardiogenic shock, but it can be used as an adjunct to norepinephrine in patients who are refractory to other vasopressors.
Vasopressin may be particularly useful in patients with septic shock, as it has been shown to improve outcomes in this population.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.