A client with diabetes is scheduled for a CT scan of the abdomen with oral and IV contrast. Which medication would be of concern?
Insulin glargine (Lantus)
Acarbose (Precose)
Metformin (Glucophage)
Glipizide (Glucotrol)
The Correct Answer is C
Choice A rationale:
Insulin glargine (Lantus) is a long-acting insulin that does not have any immediate effect on blood glucose levels. It is not typically a concern for patients undergoing CT scans with contrast.
However, it is important to monitor blood glucose levels closely in patients with diabetes who are receiving insulin therapy, as the contrast media used in CT scans can sometimes cause hyperglycemia.
Choice B rationale:
Acarbose (Precose) is an alpha-glucosidase inhibitor that works by slowing the absorption of carbohydrates from the intestines. This can help to reduce blood glucose levels after meals.
Acarbose is not typically a concern for patients undergoing CT scans with contrast. However, it is important to note that acarbose can sometimes cause gastrointestinal side effects, such as bloating, gas, and diarrhea. These side effects may be worsened by the contrast media used in CT scans.
Choice C rationale:
Metformin (Glucophage) is a biguanide that works by reducing glucose production in the liver and increasing insulin sensitivity in the muscles. It is a commonly used medication for the treatment of type 2 diabetes.
Metformin is a concern for patients undergoing CT scans with contrast because it can increase the risk of lactic acidosis. Lactic acidosis is a serious condition that can occur when there is a buildup of lactic acid in the blood. It can be caused by metformin, as well as by other factors such as dehydration, kidney problems, and liver problems.
The contrast media used in CT scans can also increase the risk of lactic acidosis. This is because the contrast media can sometimes cause kidney damage, which can impair the body's ability to remove lactic acid from the blood.
For this reason, metformin is typically discontinued for 48 hours before a CT scan with contrast. It is also important to ensure that patients are well-hydrated before and after the scan.
Choice D rationale:
Glipizide (Glucotrol) is a sulfonylurea that works by stimulating the release of insulin from the pancreas. It is a commonly used medication for the treatment of type 2 diabetes.
Glipizide is not typically a concern for patients undergoing CT scans with contrast. However, it is important to monitor blood glucose levels closely in patients with diabetes who are receiving sulfonylurea therapy, as the contrast media used in CT scans can sometimes cause hypoglycemia.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Rationale for Choice A:
Repeating the dose of nitroglycerin SL is not recommended at this time due to the patient's hypotension (blood pressure of 88/68 mmHg).
Administering additional nitroglycerin could further lower the blood pressure, potentially leading to adverse consequences such as dizziness, lightheadedness, or even fainting.
It's crucial to prioritize patient safety and avoid actions that could exacerbate their condition. Rationale for Choice B:
Notifying the provider is the most appropriate action in this situation for several reasons:
The patient's chest pain has not been relieved by the initial dose of nitroglycerin, indicating a need for further evaluation and potential adjustments to the treatment plan.
The patient's blood pressure is low, which warrants close monitoring and possible intervention to prevent complications.
The provider can assess the patient's overall clinical picture, including other symptoms and medical history, to determine the best course of action.
Early notification allows for timely interventions and potential prevention of further complications. Rationale for Choice C:
While nitroglycerin by translingual spray may be considered in some cases of persistent angina, it's not the most appropriate choice in this situation due to the patient's hypotension.
The translingual spray can also have a rapid onset of action, which might further lower the blood pressure if not carefully monitored.
It's essential to consider the patient's overall hemodynamic status before administering any medication that could potentially affect blood pressure.
Rationale for Choice D:
Administering NPH insulin is not relevant to the management of angina or chest pain.
Insulin is used to treat hyperglycemia in patients with diabetes, and its administration would not address the underlying issue of the patient's chest pain.
It's important to select interventions that are directly targeted at the patient's presenting symptoms and condition.
Correct Answer is C
Explanation
Choice A rationale:
Norepinephrine is a potent vasoconstrictor, meaning it narrows blood vessels. It primarily acts on arteries, but it can also constrict veins to a lesser extent.
Its primary actions are to increase systemic vascular resistance and blood pressure.
It is often used in conditions such as shock to raise blood pressure and improve perfusion to vital organs.
It is not a vasodilator and would not be appropriate for a patient requiring dilation of both arteries and veins.
Choice B rationale:
Nitroglycerin is a vasodilator that primarily acts on veins. It relaxes the smooth muscle in the walls of veins, which allows them to dilate and hold more blood.
This reduces the amount of blood returning to the heart, which in turn lowers preload and reduces cardiac workload.
Nitroglycerin is often used to treat angina pectoris, a condition characterized by chest pain due to insufficient blood flow to the heart.
While it can also have some vasodilatory effects on arteries, its primary action is on veins.
Choice C rationale:
Nitroprusside sodium (Nitropress) is a potent vasodilator that acts on both arteries and veins. It directly relaxes smooth muscle in the blood vessel walls, leading to dilation.
It is a very powerful vasodilator and can rapidly lower blood pressure.
It is often used in hypertensive emergencies to quickly reduce blood pressure and improve cardiac function.
It is also used in conditions such as congestive heart failure and acute aortic dissection to reduce afterload and improve cardiac output.
Choice D rationale:
Lidocaine is a local anesthetic agent that is primarily used to block nerve conduction. It does not have any direct vasodilatory effects.
It is sometimes used in the treatment of cardiac arrhythmias, but its mechanism of action in this setting is not related to vasodilation.
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