Chapter 40: Antidiabetic Drugs Introductory Clinical Pharmacology 12th Edition by Susan M Ford

Introductory Clinical Pharmacology 12th Edition by Susan M Ford 1. A client with hyperinsulinism has been prescribed diazoxide. After administration, which adverse reaction should the nurse prioritize? a. Myalgia b. Tachycardia c. Flatulence d. Epigastric discomfort Answer: B Rationale: The nurse should monitor for tachycardia, congestive heart failure, sodium and fluid retention, hyperglycemia, and glycosuria as the adverse reactions in the client receiving diazoxide drug therapy. Myalgia, fatigue, and headache are the adverse reactions observed in clients undergoing pioglitazone HCl drug therapy. Flatulence is one of the adverse reactions found in clients receiving metformin drug therapy. Epigastric discomfort is one of the adverse reactions observed in clients receiving acetohexamide drugs. Question Format: Multiple Choice Chapter: 40 Learning Objective: 2 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 546, Summary Drug Table 2. A nurse is teaching a client about acarbose. The nurse determines the teaching is successful when the client correctly states which instruction to follow when administering the drug at home? a. Administer the drug with breakfast. b. Expect to add an oral sulfonylurea with the drug. c. Administer the drug with the first bite of the meal. d. Report unusual somnolence to the primary health care provider. Answer: C Rationale: Acarbose should be administered with the first bite of the meal. Glyburide needs to be administered with breakfast. An oral sulfonylurea will likely be added to metformin if the client does not experience a response in 4 weeks using the maximum dose of metformin. Clients taking metformin may experience unusual somnolence, of which the nurse should inform the primary health care provider. Question Format: Multiple Choice Chapter: 40 Learning Objective: 5 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 533, Alpha-Glucosidase Inhibitors 3. The nurse has administered glipizide and warfarin to a client. Which finding on assessment should the nurse prioritize? a. Increased risk of lactic acidosis b. Risk of acute renal failure c. Increased risk for bleeding d. Increased hypoglycemic effect Answer: D Rationale: The nurse should observe for increased hypoglycemic effect in the client as the effect of the interaction of sulfonylureas (glipizide) with the anticoagulants (warfarin), chloramphenicol, clofibrate, fluconazole, histamine-2 antagonists, methyldopa, monoamine oxidase inhibitors (MAOIs), salicylates, sulfonamides, and tricyclic antidepressants. Increased risk of lactic acidosis is an effect of the interaction of metformin with glucocorticoids. Increased risk for bleeding is an effect of the interaction of oral anticoagulants with anti-infective drugs. There is a risk of acute renal failure when iodinated contrast material used for radiologic studies is administered with metformin. Question Format: Multiple Choice Chapter: 40 Learning Objective: 2 Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 534, Sulfonylureas 4. A nurse is caring for a client with diabetes mellitus who is receiving an oral antidiabetic drug. Which ongoing assessments should the nurse prioritize when caring for this client? a. Assess the skin for ulcers, cuts, and sores. b. Observe the client for hypoglycemic episodes. c. Monitor the client for lipodystrophy. d. Document family medical history. Answer: B Rationale: As the ongoing assessment activity, the nurse should observe the client for hypoglycemic episodes. Documenting family medical history and assessing the client's skin for ulcers, cuts, and sores should be completed before administering the drug. Lipodystrophy occurs if the sites of insulin injection are not rotated. Question Format: Multiple Choice Chapter: 40 Learning Objective: 3 Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 15, Ongoing Assessment 5. A nurse is preparing to administer insulin glargine to a client. What precaution should the nurse take when administering this drug? a. Administer glargine via IV route. b. Avoid mixing glargine with other insulins. c. Shake the vial vigorously before withdrawing insulin. d. Be sure the insulin has been refrigerated. Answer: B Rationale: When administering insulin glargine to the client, the nurse should avoid mixing it with other insulins or solutions. It will precipitate in the syringe when mixed. If glargine is mixed with another solution, it will lose glucose control, resulting in decreased effectiveness of the insulin. Glargine is administered via the subcutaneous route once daily at bedtime. The nurse should not shake the vial vigorously before withdrawing insulin. The vial should be gently rotated between the palms of the hands and tilted gently end to end immediately before withdrawing the insulin. The nurse administers insulin from vials at room temperature. Vials are stored in the refrigerator if they are to be stored for about 3 months for later use. Question Format: Multiple Choice Chapter: 40 Learning Objective: 5 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 538, Mixing Insulins 6. A nurse is preparing to administer insulin to the client. Which interventions should the nurse perform before administering each insulin dose? a. Inspect the previous injection site for inflammation. b. Keep prefilled syringes horizontally. c. Check for symptoms of myalgia or malaise. d. Mix the insulin with sterile water in the syringe.