A client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which symptom when caring for this client?
Polyuria
Blurred vision
Polydipsia
Hypoglycemia
The Correct Answer is D
Oral antidiabetic agents, such as sulfonylureas or meglitinides, lower blood glucose by stimulating pancreatic secretion or improving insulin sensitivity. The most critical adverse effect is a rapid decline in plasma glucose levels below 70 mg/dL. Severe episodes can lead to neuroglycopenia, manifested by confusion, seizures, or loss of consciousness if not promptly treated.
A. Polyuria: Excessive urination is a hallmark of hyperglycemia, where osmotic diuresis occurs as the kidneys excrete excess glucose. While common in undiagnosed or poorly managed diabetes, it is not a direct side effect of glucose-lowering medications. Monitoring for this symptom helps identify therapeutic failure rather than acute drug-induced complications.
B. Blurred vision: Visual disturbances often occur due to osmotic shifts in the lens during periods of fluctuating or very high blood sugar. This symptom is generally associated with the initial presentation of diabetes or chronic lack of glycemic control. It is less likely to be a primary indicator of an acute adverse reaction to oral medications.
C. Polydipsia: Excessive thirst is the body’s compensatory mechanism to counter the fluid loss caused by osmotic diuresis in hyperglycemic states. Like polyuria, it indicates that the oral agent may not be sufficiently controlling the client's blood glucose levels. It serves as a clinical marker for the need to increase or adjust the medication dosage.
D. Hypoglycemia: Pharmacological stimulation of insulin release can cause blood sugar to drop to dangerously low levels, especially if meals are skipped. The nurse must monitor for autonomic symptoms like diaphoresis, tachycardia, and tremors. This represents the most immediate and life-threatening risk associated with specific classes of oral antidiabetic therapy.
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Related Questions
Correct Answer is C
Explanation
Hypoglycemia, defined as a blood glucose below 70 mg/dL, triggers an immediate sympathoadrenal response to stimulate glucose release. As levels drop further, the central nervous system suffers from a lack of fuel, leading to altered mentation and cognitive decline. If untreated, the brain's metabolic requirements cannot be met, resulting in loss of consciousness, permanent brain injury, or death.
A. Polyuria, polydipsia, hypotension, and hypernatremia: These signs are characteristic of severe hyperglycemia and dehydration, often seen in Hyperosmolar Hyperglycemic State (HHS). High glucose causes osmotic diuresis, leading to massive fluid loss and elevated sodium concentrations. These symptoms are the physiologic opposite of the clinical picture presented by a low glucose level of 45 mg/dL.
B. Kussmaul's respirations, dry skin, hypotension, and bradycardia: Kussmaul's breathing is a compensatory mechanism for metabolic acidosis, specifically seen in diabetic ketoacidosis (DKA) due to high blood sugar. Dry skin reflects dehydration caused by prolonged hyperglycemia, whereas hypoglycemia typically presents with diaphoresis. These findings indicate acidotic states rather than an acute drop in plasma glucose.
C. Coma, anxiety, confusion, headache, and cool, moist skin: These symptoms reflect the dual impact of neuroglycopenia and epinephrine release. Cool, clammy skin is a classic adrenergic sign as the body attempts to raise glucose levels through sympathetic activation. Confusion and headache are early indicators of cerebral glucose deprivation, which can quickly progress to a comatose state.
D. Polyuria, polydipsia, polyphagia, and weight loss: This triad of symptoms, known as the "3 Ps," defines the clinical presentation of undiagnosed or poorly controlled hyperglycemia. In the absence of insulin, glucose cannot enter cells, leading to cellular starvation and weight loss despite increased intake. These symptoms develop over days or weeks, not as a result of acute hypoglycemia.
Correct Answer is ["42"]
Explanation
Regular insulin (short-acting) and NPH insulin (intermediate-acting) are both compatible and can be mixed in the same syringe. The correct technique is to draw up the regular insulin first (to avoid contaminating the vial with NPH), then draw up the NPH insulin.
- Total dose = 14 units (regular) + 28 units (NPH) = 42 units in one syringe.
Correct answer: The nurse should prepare 1 syringe containing both insulins.
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