A patient is scheduled to start taking insulin glargine (Lantus). On the care plan, the nurse should include which of these outcomes related to the therapeutic effects of the medication?

Choice A reason: Enterochromaffin-like (ECL) cells release histamine, which stimulates parietal cells to secrete hydrochloric acid via H2 receptors. This increases gastric acid production, critical for digestion, and is a key component in the acid secretion pathway, making this a correct choice for acid-increasing cells.

Choice B reason: Beta cells, located in the pancreas, secrete insulin to regulate glucose, not gastric acid. They have no role in stomach acid production or regulation, which is controlled by gastric cells like parietal or G cells, making this choice incorrect.

Choice C reason: Parietal cells directly secrete hydrochloric acid into the stomach lumen via the H+/K+-ATPase pump, significantly increasing gastric acidity for digestion. Activated by histamine, gastrin, and acetylcholine, they are central to acid production, making this a correct choice for the question.

Choice D reason: Mucus cells secrete protective mucus to shield the stomach lining from acid and pepsin, not acid itself. They reduce damage from acidity but don’t contribute to its production, making this choice incorrect for cells that increase stomach acid.

Choice E reason: G cells secrete gastrin, a hormone that stimulates parietal cells to produce hydrochloric acid. Gastrin enhances acid secretion indirectly by activating parietal cells and ECL cells, playing a key role in gastric acid regulation, making this a correct choice.

Choice A reason: Drugs with a narrow therapeutic range, like digoxin, require plasma level monitoring to ensure concentrations remain within a safe and effective range. This prevents toxicity (e.g., arrhythmias) or subtherapeutic effects, as small dose changes can significantly alter blood levels, making monitoring critical for patient safety and efficacy.

Choice B reason: Intravenous administration does not inherently address the risks of a narrow therapeutic range. While it ensures rapid delivery, it increases toxicity risk due to immediate bioavailability. Monitoring plasma levels is more critical than the route to maintain safe and effective drug concentrations, making this choice less appropriate.

Choice C reason: Administering at intervals longer than the half-life may lead to subtherapeutic levels for drugs with a narrow therapeutic range, reducing efficacy. Consistent dosing and plasma level monitoring are needed to maintain steady-state concentrations within the therapeutic window, making this choice incorrect for managing such drugs.

Choice D reason: Teaching that maximum effects occur quickly is inaccurate for most narrow therapeutic range drugs, which often require steady-state concentrations over time. Without monitoring, toxicity or inefficacy risks increase. Patient education should focus on adherence and monitoring, not rapid effects, making this choice inappropriate.