A client with type 2 diabetes mellitus who takes glimepiride PO daily calls the nurse to report a recent onset of nausea, vomiting, and diarrhea. Which response should the nurse provide?
Use insulin sliding scale until symptoms are resolved.
Return to the clinic for laboratory tests for an infection.
Schedule a visit for evaluation by the healthcare provider (HCP).
Increase oral fluid intake until these symptoms subside.
The Correct Answer is C
A. Use insulin sliding scale until symptoms are resolved: Starting insulin without an evaluation would be inappropriate. A sliding scale may eventually be needed if blood sugars fluctuate, but the priority is to assess the cause of the gastrointestinal symptoms first.
B. Return to the clinic for laboratory tests for an infection: Although an infection could be a cause, nausea, vomiting, and diarrhea in a diabetic client also raise concern for possible medication issues, dehydration, or even metabolic disturbances. Immediate evaluation is necessary before simply ordering lab tests.
C. Schedule a visit for evaluation by the healthcare provider (HCP): New gastrointestinal symptoms could indicate a significant underlying issue such as medication intolerance, dehydration, or even diabetic ketoacidosis (though less common in type 2). An urgent clinical assessment by the HCP is most appropriate.
D. Increase oral fluid intake until these symptoms subside: While staying hydrated is important, advising fluids alone without a thorough assessment risks missing a serious underlying cause. Symptom management should not replace a proper medical evaluation.
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Related Questions
Correct Answer is D
Explanation
A. Monitor urinary output: While monitoring output is important, it does not provide immediate diagnostic information regarding the cause of the client’s thirst. It is a supportive action but not the most efficient first step to investigate potential hyperglycemia.
B. Notify the healthcare provider (HCP): Notifying the HCP is appropriate if there are abnormal findings or the client’s condition worsens. However, the nurse should gather objective data—such as a blood glucose reading—before contacting the provider.
C. Prepare to give insulin: Insulin should not be administered without confirmation of elevated blood glucose. Giving insulin without verifying hyperglycemia could lead to serious complications, including hypoglycemia.
D. Obtain fingerstick blood glucose: Methylprednisolone, a corticosteroid, can raise blood glucose levels, and excessive thirst is a classic symptom of hyperglycemia. Checking the client’s blood glucose is the most appropriate first action to determine if elevated glucose is causing the symptom.
Correct Answer is A
Explanation
A. Serum liver enzymes: Statins are metabolized in the liver and can cause hepatotoxicity. Baseline liver enzyme levels, such as ALT and AST, should be reviewed before starting statin therapy to ensure the liver is functioning properly and to monitor for potential adverse effects.
B. Serum electrolytes: Electrolytes are important for overall health, but they are not specifically impacted by statin therapy. Reviewing electrolyte levels is not a priority before initiating statins unless other conditions warrant it.
C. Complete blood count: A complete blood count (CBC) provides valuable information about infection or anemia, but it is not directly related to the safety or monitoring of statin medications.
D. Capillary blood glucose: Statins have been associated with a slight risk of elevated blood glucose over long-term use, but an initial capillary blood glucose reading is not required prior to starting therapy. Liver function assessment is the priority.
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