A nurse is providing teaching to a client who has a new diagnosis of type 2 diabetes mellitus. The nurse should recognize that the client understands the teaching when he identifies which of the following as manifestations of hypoglycemia? (Select all that apply.)

Choice A reason: Distribution is not the correct term to describe the movement of a drug from its site of administration to the bloodstream. Distribution is the process by which a drug moves from the bloodstream to the tissues and organs of the body. Distribution depends on factors such as blood flow, tissue permeability, plasma protein binding, and tissue binding. Distribution occurs after the drug has been absorbed into the bloodstream, and it determines how much drug reaches the site of action.

Choice B reason: Metabolism is not the correct term to describe the movement of a drug from its site of administration to the bloodstream. Metabolism is the process by which a drug is chemically transformed in the body, usually by enzymes in the liver or other tissues. Metabolism can affect the activity, duration, and elimination of a drug. Metabolism occurs after the drug has been absorbed into the bloodstream, and it can occur before or after the drug reaches the site of action.

Choice C reason: Excretion is not the correct term to describe the movement of a drug from its site of administration to the bloodstream. Excretion is the process by which a drug or its metabolites are eliminated from the body. Excretion can occur through various routes, such as urine, feces, sweat, or breath. Excretion occurs after the drug has been absorbed into the bloodstream, and it can occur before or after the drug reaches the site of action.

Choice D reason: Absorption is the correct term to describe the movement of a drug from its site of administration to the bloodstream. Absorption is the process by which a drug enters the bloodstream from the site of administration. Absorption depends on factors such as the route of administration, the dose, the formulation, and the bioavailability of the drug. Absorption is the first step of pharmacokinetics, and it determines how much and how fast a drug reaches the bloodstream and the site of action.

Choice A reason: CT scan with contrast is an order that the nurse should question for the client who is taking metformin for hyperglycemia. Metformin is a medication that lowers the blood glucose level by decreasing the hepatic glucose production and increasing the insulin sensitivity¹. Metformin can cause a rare but serious complication called lactic acidosis, which is a buildup of lactic acid in the blood that can cause symptoms such as weakness, nausea, vomiting, or breathing problems. CT scan with contrast involves injecting iodinated contrast material into the bloodstream, which can affect the kidney function and increase the risk of lactic acidosis in patients taking metformin. The nurse should consult with the prescriber and the pharmacist about the need to stop metformin before and after the CT scan with contrast, and to monitor the kidney function and the blood glucose level of the client.

Choice B reason: Chest X-ray 1 view is not an order that the nurse should question for the client who is taking metformin for hyperglycemia. Chest X-ray is a diagnostic test that uses a small amount of radiation to produce images of the lungs, heart, and chest wall. Chest X-ray does not involve any contrast material or affect the kidney function or the blood glucose level. The nurse should follow the standard precautions and procedures for performing a chest X-ray, such as verifying the client's identity, checking for pregnancy, removing any metal objects, and positioning the client properly.

Choice C reason: V/Q scan is not an order that the nurse should question for the client who is taking metformin for hyperglycemia. V/Q scan is a diagnostic test that measures the ventilation and perfusion of the lungs, and can detect any abnormalities such as pulmonary embolism or chronic obstructive pulmonary disease. V/Q scan involves injecting a radioactive tracer into the bloodstream and inhaling a radioactive gas, which are then detected by a special camera. V/Q scan does not affect the kidney function or the blood glucose level. The nurse should follow the standard precautions and procedures for performing a V/Q scan, such as verifying the client's identity, checking for allergies, explaining the procedure, and monitoring the vital signs.

Choice D reason: Bilateral lower extremity ultrasound is not an order that the nurse should question for the client who is taking metformin for hyperglycemia. Bilateral lower extremity ultrasound is a diagnostic test that uses sound waves to produce images of the blood vessels in the legs, and can detect any abnormalities such as deep vein thrombosis or peripheral arterial disease. Bilateral lower extremity ultrasound does not involve any contrast material or affect the kidney function or the blood glucose level. The nurse should follow the standard precautions and procedures for performing a bilateral lower extremity ultrasound, such as verifying the client's identity, explaining the procedure, and applying a gel and a probe to the legs.