A patient with type 2 diabetes is prescribed glipizide (Glucotrol) 10 mg orally before meals.
The patient inquires, “What is the mechanism of action of this medication in managing my diabetes?” How should the nurse respond?
It enhances glucose transport into the muscles.
It facilitates glucose utilization by body cells.
It boosts glucose levels to provide more energy to the body.
It triggers beta cells in the pancreas to release insulin, thereby reducing blood glucose levels.
The Correct Answer is D
Choice A rationale:
Glipizide does not directly enhance glucose transport into the muscles. This action is primarily mediated by insulin, which increases the expression of glucose transporter proteins (GLUT4) on muscle cell membranes, facilitating glucose uptake.
While glipizide can indirectly improve glucose transport into muscles by increasing insulin levels, it's not the primary mechanism of action.
Choice B rationale:
Glipizide does not directly facilitate glucose utilization by body cells. This process also largely depends on insulin, which activates intracellular pathways that promote glucose metabolism and energy production.
Although glipizide can indirectly enhance glucose utilization by increasing insulin availability, it's not the main mechanism responsible for its glucose-lowering effects.
Choice C rationale:
Glipizide does not boost glucose levels. In fact, it has the opposite effect, lowering blood glucose levels by stimulating insulin secretion.
Elevating glucose levels would be counterproductive in diabetes management, as the goal is to maintain blood glucose within a healthy range.
Choice D rationale (correct answer):
Glipizide belongs to a class of medications called sulfonylureas, which act primarily by stimulating insulin secretion from pancreatic beta cells.
Insulin is a hormone that plays a crucial role in regulating blood glucose levels. It promotes glucose uptake by various tissues, including muscles, liver, and adipose tissue, and it inhibits glucose production by the liver.
By triggering insulin release, glipizide effectively lowers blood glucose levels. This helps to prevent the long-term complications of diabetes, such as damage to blood vessels, nerves, and organs.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale:
Hypertension is not a primary contraindication for mannitol use. While it's important to monitor blood pressure during mannitol administration, it's not the most concerning factor in this scenario.
Mannitol can even be used cautiously in hypertensive patients with conditions like intracranial hypertension or acute renal failure, where its benefits may outweigh the potential risks of exacerbating hypertension.
Choice B rationale:
Mannitol is actually indicated for the treatment of increased intracranial pressure (ICP). It works by drawing fluid from the brain tissues into the bloodstream, thereby reducing pressure within the skull.
Therefore, a patient with ICP would not be a concern for mannitol administration; rather, they would be a potential candidate for its use.
Choice D rationale:
While fluid volume overload can be a concern with mannitol use, it's typically managed with careful monitoring and fluid restriction.
The more significant concern in this scenario is congestive heart failure (CHF).
Choice C rationale:
Mannitol is contraindicated in patients with congestive heart failure (CHF). Here's why:
Increased Circulating Volume: Mannitol is an osmotic diuretic, meaning it draws fluid from the tissues into the bloodstream, increasing circulating blood volume. This can overload the already compromised heart in CHF patients, leading to worsening heart failure and pulmonary edema.
Elevated Blood Pressure: Mannitol can also cause a transient increase in blood pressure due to its osmotic effects. This can further strain the heart and worsen CHF symptoms.
Renal Impairment: CHF patients often have impaired renal function, which can reduce their ability to excrete mannitol effectively. This can lead to fluid retention and electrolyte imbalances, further complicating CHF management.
In summary, administering mannitol to a patient with CHF could potentially lead to:
Exacerbation of heart failure symptoms Pulmonary edema
Worsening renal function Electrolyte imbalances Increased risk of mortality
Therefore, it's crucial to avoid mannitol use in patients with CHF and to closely monitor fluid status and electrolytes in those who must receive it for other indications.
Correct Answer is C
Explanation
Choice A rationale:
Insulin resistance is a condition in which the body's cells become less responsive to insulin, requiring more insulin to maintain normal blood glucose levels.
It's primarily caused by factors such as obesity, physical inactivity, and genetic predisposition. Rotating injection sites does not directly address these underlying causes of insulin resistance.
It can help ensure consistent insulin absorption, but it's not the primary mechanism for preventing insulin resistance.
Choice B rationale:
Allergic reactions to insulin are rare but can occur.
They typically manifest as localized symptoms at the injection site, such as redness, swelling, itching, or pain.
In severe cases, systemic reactions like hives, difficulty breathing, or anaphylaxis can occur.
Rotating injection sites might reduce the risk of localized allergic reactions by preventing repeated exposure to insulin in the same area of skin.
However, it does not prevent systemic allergic reactions, which are immune-mediated and not dependent on the injection site.
Choice C rationale:
Lipodystrophy is a condition characterized by abnormal changes in fat distribution under the skin. It can occur as a complication of repeated insulin injections at the same site.
There are two main types of lipodystrophy:
Lipohypertrophy: This involves the accumulation of excess fatty tissue at injection sites, creating visible lumps or bumps. Lipoatrophy: This involves the loss of fatty tissue at injection sites, leading to depressions or indentations in the skin.
Both lipohypertrophy and lipoatrophy can interfere with insulin absorption, leading to unpredictable blood glucose control.
Rotating injection sites helps to prevent lipodystrophy by distributing insulin injections over a wider area of skin, reducing the likelihood of repeated trauma to the same tissue.
Choice D rationale:
Insulin shock, also known as hypoglycemia, is a condition that occurs when blood glucose levels drop too low.
It can be caused by several factors, including excessive insulin dosing, missed meals, or increased physical activity. Rotating injection sites does not directly affect the risk of insulin shock.
It's essential for individuals using insulin to monitor their blood glucose levels regularly, adjust insulin doses as needed, and follow a balanced diet and exercise plan to prevent hypoglycemia.
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