A patient was taking metformin before this hospitalization.

To facilitate better glucose control, the patient has been switched to insulin therapy while hospitalized.

The patient asks the nurse why it is so important to time meals with the insulin injection and to give him an example of a long-acting insulin.

Which drug will the nurse tell the patient is a long-acting insulin?

Choice A rationale

Aspirin does not typically increase urine output. In fact, in large doses, it can cause renal impairment leading to decreased urine output. Aspirin is a non-steroidal anti-inflammatory drug (NSAID) and can be nephrotoxic, particularly with long-term use or in high doses, but it is not a diuretic.

Choice B rationale

Aspirin does not cause hyponatremia. Hyponatremia is a low sodium level in the blood (normal range 135-145 mEq/L) and is often associated with conditions like fluid overload or the use of certain diuretics. Aspirin's primary effects are on platelet aggregation and inflammation, not electrolyte balance.

Choice C rationale

Aspirin does not cause elevated blood glucose levels. Medications that typically cause hyperglycemia include corticosteroids, some diuretics, and certain antipsychotics. Aspirin's primary mechanism of action involves inhibiting cyclooxygenase enzymes, which are not directly involved in glucose metabolism.

Choice D rationale

Aspirin is an antiplatelet medication that irreversibly inhibits cyclooxygenase-1 (COX-1), preventing the formation of thromboxane A2 and subsequent platelet aggregation. This increases the risk of bleeding. The nurse must monitor for signs of hemorrhage, such as bruising, petechiae, blood in the stool (melena), or coffee-ground emesis.

Choice A rationale

Ethambutol is an antituberculosis medication. The combination of a sore throat and fever can be indicative of a serious and potentially life-threatening adverse effect of the medication, such as hepatotoxicity or bone marrow suppression, which could manifest as agranulocytosis. Continuing the medication would be highly dangerous and could worsen the patient's condition.

Choice B rationale

Sore throat and fever can signal a severe systemic reaction to ethambutol, potentially indicating drug-induced agranulocytosis or hepatotoxicity. Agranulocytosis, characterized by a critically low white blood cell count (normal range for WBC is 4,500 to 11,000 cells/mm), leaves the body vulnerable to overwhelming infection. Immediate discontinuation of the drug and notifying the healthcare provider is the essential nursing action.

Choice C rationale

Increasing the dose of a medication when a patient is exhibiting signs of a potential adverse drug reaction is contraindicated. The symptoms of sore throat and fever suggest a systemic inflammatory or immune response to the drug. Increasing the dose would likely exacerbate the toxicity and further harm the patient, potentially leading to a more severe outcome.

Choice D rationale

A sore throat and fever in a patient on ethambutol could be a sign of a severe adverse drug reaction, not just a simple bacterial infection. While an infection may be present, the primary concern is the potential for bone marrow suppression. Prescribing an antibiotic without a proper diagnosis would be an inappropriate nursing action, as it is outside the scope of practice and would fail to address the underlying issue.