A patient who has type 2 diabetes is being prepared for an elective coronary angiogram. Which information would the nurse anticipate might lead to rescheduling the test?
The patient took the prescribed metformin today.
The patient's blood glucose is 128 mg/dL.
The patient's most recent A1C was 7.5%.
The patient took the prescribed enalapril 4 hours ago.
The Correct Answer is A
Rationale:
A. The patient took the prescribed metformin today: Metformin should be withheld before contrast dye procedures because it increases the risk of lactic acidosis if renal impairment occurs. This would likely lead to rescheduling the angiogram until the drug is cleared.
B. The patient's blood glucose is 128 mg/dL: A glucose level of 128 mg/dL is within an acceptable range for a diabetic patient and would not require postponing the procedure.
C. The patient's most recent A1C was 7.5%: An A1C of 7.5% shows moderately controlled diabetes, but it is not an immediate contraindication to proceeding with an angiogram.
D. The patient took the prescribed enalapril 4 hours ago: ACE inhibitors such as enalapril are commonly continued unless specifically contraindicated. This does not typically warrant delaying the procedure.
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Related Questions
Correct Answer is C
Explanation
Rationale:
A. Initiate an insulin infusion: Insulin lowers blood glucose levels and would worsen hypoglycemia. It is contraindicated in this situation and never used as treatment for low blood sugar.
B. Administer oral glucose tablets: Oral glucose is effective only if the patient is awake, alert, and able to swallow safely. An unconscious patient cannot take anything orally due to aspiration risk, making this inappropriate.
C. Administer 50% dextrose (D50) injection: Intravenous dextrose is the first-line treatment for severe hypoglycemia in an unconscious patient because it rapidly restores blood glucose. It works immediately and is the safest and most effective emergency intervention.
D. Provide glucagon injection: Glucagon can be used when IV access is unavailable, as it stimulates glycogenolysis in the liver. However, its effect is slower compared to IV dextrose, which is why glucagon is considered a secondary option rather than the first-line treatment.
Correct Answer is D
Explanation
Rationale:
A. "You may crush or chew the medication": Metformin XR is an extended-release formulation and should not be crushed or chewed. Altering the tablet disrupts the extended-release mechanism, leading to rapid absorption, increased side effects, and loss of therapeutic benefit.
B. "This medication may turn your urine orange": Orange-colored urine is commonly associated with rifampin or phenazopyridine use, not metformin. Metformin does not cause urine discoloration, so this teaching would not be accurate for a client with type II diabetes.
C. "This medication may cause an increase in perspiration": Increased sweating is linked to hypoglycemia, especially with sulfonylureas or insulin, but metformin does not usually cause this effect. Its side effects are more commonly gastrointestinal, such as diarrhea, nausea, and abdominal discomfort.
D. "Take the medication with a meal": Taking metformin with meals helps reduce gastrointestinal side effects, which are the most common complaints with this drug. Food improves tolerability without decreasing the drug’s effectiveness.
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