A client diagnosed with type 2 diabetes will begin taking metformin (Glucophage). The nurse understands that the client is at risk for which serious condition(s) when taking metformin (Glucophage)?
Respiratory distress
Seizures
Lactic acidosis and renal failure
Hyperglycemia
The Correct Answer is C
Choice A rationale:
Respiratory distress is not a direct side effect of metformin. While metformin can cause a rare condition called lactic acidosis, which can lead to rapid breathing, respiratory distress is not a primary concern with metformin use.
Respiratory distress typically involves difficulty breathing due to other causes such as asthma, pneumonia, heart failure, or chronic obstructive pulmonary disease (COPD).
Choice B rationale:
Seizures are not a known side effect of metformin.
Seizures are typically associated with neurological conditions, such as epilepsy, or metabolic disturbances such as hypoglycemia or electrolyte imbalances.
Metformin does not directly affect the central nervous system in a way that would increase the risk of seizures.
Choice C rationale:
Lactic acidosis:
This is a rare but serious condition that can occur with metformin use.
It happens when lactic acid builds up in the bloodstream, causing the blood to become too acidic. Symptoms of lactic acidosis include:
Rapid breathing Nausea and vomiting Abdominal pain Muscle weakness Unusual sleepiness Feeling cold
Risk factors for lactic acidosis in patients taking metformin include:
Kidney disease Congestive heart failure Liver disease Dehydration
Excessive alcohol intake Recent surgery or heart attack
It's important to note that lactic acidosis is rare, occurring in about 3 to 10 cases per 100,000 people taking metformin per year.
Renal failure:
Metformin is primarily eliminated by the kidneys.
If kidney function is impaired, metformin can build up in the body, increasing the risk of lactic acidosis. Additionally, metformin can potentially cause kidney damage in rare cases, further worsening kidney function. It's crucial to monitor kidney function regularly in patients taking metformin.
Choice D rationale:
Hyperglycemia (high blood sugar) is not a side effect of metformin.
In fact, metformin is a medication used to lower blood sugar levels in people with type 2 diabetes. It works by:
Decreasing the amount of glucose produced by the liver Improving the body's sensitivity to insulin
Slowing the absorption of glucose from the intestines
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Naxlex Comprehensive Predictor Exams
Related Questions
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.
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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