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)

Answer and Explanation

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.

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Correct Answer is A

Explanation

Choice A rationale:

Requesting that the patient eat lunch first if testing is further delayed is the most appropriate action to prevent hypoglycemia for the following reasons:

1. Timing of NPH Insulin Peak:

NPH insulin is an intermediate-acting insulin with a peak action time of 4-12 hours after administration.

In this case, the patient received NPH insulin at 7:00 AM, meaning its peak effect is likely to occur between 11:00 AM and 5:00 PM.

Delaying lunch beyond 1:00 PM significantly increases the risk of hypoglycemia as the insulin's action peaks without adequate food intake to balance glucose levels.

2. Ensuring Consistent Mealtimes:

Consistency in meal timing is crucial for managing blood glucose levels in diabetic patients. Delaying meals can disrupt the balance between insulin and glucose, leading to hypoglycemia.

Prioritizing lunch at the usual time, even amidst testing delays, helps maintain a more predictable glucose pattern.

3. Addressing Acute Hypoglycemia Risk:

Hypoglycemia is a serious complication of diabetes that can occur if blood glucose levels fall too low. Symptoms can include shakiness, sweating, dizziness, confusion, and even loss of consciousness.

Promptly addressing potential delays in food intake is essential to prevent hypoglycemia and its associated risks.

Rationales for other choices:

Choice B: Discontinuing the evening dose of insulin does not address the immediate risk of hypoglycemia due to the missed lunch. It could lead to hyperglycemia later in the day or overnight.

Choice C: Saving the lunch tray for later may not be feasible if testing is significantly delayed. It also does not prevent hypoglycemia in the immediate timeframe.

Choice D: While a glass of orange juice can provide a quick source of glucose, it is a short-term solution and does not replace a balanced meal. It could also lead to a rapid rise in blood glucose followed by a subsequent drop.

A. Assess the patient’s blood sugar using a bedside finger stick blood glucose test. B. Administer the next dose of insulin STAT. C. Administer Narcan (Naloxone) STAT. D. Administer 2L O2 via nasal cannula.

Correct Answer is A

Explanation

Choice A rationale:

Hypoglycemia is a critical consideration: The patient's symptoms of lethargy, diaphoresis, and combativeness, along with recent insulin administration, raise a strong suspicion of hypoglycemia (low blood sugar). Hypoglycemia can quickly progress to coma and seizures if not promptly treated, making it a high priority to assess and address.

Bedside glucose testing is rapid and reliable: A bedside finger stick blood glucose test is a quick, non-invasive, and accurate way to determine the patient's blood sugar level. It provides immediate results, allowing for prompt intervention if hypoglycemia is confirmed.

Other assessments and interventions can follow: Once hypoglycemia is ruled out or confirmed, the nurse can proceed with other assessments and interventions as needed.

Choice B rationale:

Insulin administration without blood sugar confirmation is dangerous: Administering insulin without first checking the patient's blood sugar could worsen hypoglycemia if it is already present. This could lead to severe complications, including neurological damage or even death.

Insulin timing is not a priority: While the next dose of insulin may be due, its administration is not the most urgent priority in this situation. Addressing the patient's immediate symptoms and potential hypoglycemia takes precedence.

Choice C rationale:

Naloxone is not indicated for hypoglycemia: Naloxone is an opioid antagonist used to reverse opioid overdose. It has no effect on hypoglycemia and would not be appropriate in this case.

Choice D rationale:

Oxygen therapy may not address the underlying issue: While oxygen therapy can be beneficial for patients with respiratory distress, it does not address the potential hypoglycemia in this case. If the patient's lethargy and combativeness are due to low blood sugar, oxygen therapy alone would not be sufficient treatment.

Oxygen saturation is already within normal limits: The patient's oxygen saturation (SPO2) is 97%, indicating that their oxygenation is currently adequate. Oxygen therapy would not be indicated unless there were signs of hypoxia.

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A client with diabetes is scheduled for a CT scan of the abdomen with oral and IV contrast. Which medication would be of concern?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

Correct Answer is A

Explanation

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