A patient with type 1 Diabetes Mellitus is admitted to the medical unit with an acute exacerbation of chronic obstructive pulmonary disease.
He is placed on IV piggyback antibiotics, nebulizer treatments with albuterol, and an IV corticosteroid, and he is also taking a proton pump inhibitor for gastroesophageal reflux disease.
He takes a dose of glargine insulin every evening.
This evening the nurse notes that his blood glucose level is 170 mg/dL. The next morning, his fasting glucose level is 202 mg/dL. What is the most likely cause of his elevated glucose levels?
The albuterol.
The corticosteroid.
The antibiotics.
The proton pump inhibitor.
The Correct Answer is B
Choice A rationale
Albuterol, a short-acting beta-2 adrenergic agonist, can cause a transient increase in blood glucose levels by stimulating glycogenolysis in the liver and muscles. This effect is dose-dependent and typically short-lived. However, the continuous and sustained elevation from 170 to 202 mg/dL is more characteristic of a medication with a longer-acting metabolic effect. While possible, it is not the most likely cause.
Choice B rationale
Corticosteroids, such as prednisone or methylprednisolone, significantly increase blood glucose by promoting gluconeogenesis and inhibiting glucose uptake by peripheral tissues, leading to insulin resistance. This effect is prolonged and dose-dependent, making it a very common cause of hyperglycemia in patients, especially those with pre-existing conditions like Type 1 Diabetes Mellitus, who are already susceptible to glucose dysregulation.
Choice C rationale
Antibiotics, in general, are not known to directly cause a sustained increase in blood glucose levels. Some antibiotics like fluoroquinolones can affect glucose metabolism, but they are more commonly associated with hypoglycemia, although hyperglycemia can also occur. The effect is not as pronounced or as likely as that of corticosteroids in this clinical scenario.
Choice D rationale
Proton pump inhibitors (PPIs) work by inhibiting the H+/K+ ATPase pump in gastric parietal cells, reducing stomach acid production. There is no established direct physiological mechanism by which PPIs cause a sustained increase in blood glucose levels. Their primary effect is on the gastrointestinal system, and they do not significantly impact carbohydrate metabolism in the way that corticosteroids do.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Taking a hypnotic medication with a large meal can delay the absorption and onset of action. For effective treatment of insomnia, these medications should be taken on an empty stomach or with a light snack to ensure rapid absorption and to help the patient fall asleep quickly as intended.
Choice B rationale
Non-benzodiazepine hypnotics are specifically formulated for sleep induction and maintenance. They have a sedative effect and should not be taken during the day, as this would impair daily functioning, alertness, and coordination, posing a significant safety risk to the patient and others.
Choice C rationale
Non-benzodiazepine hypnotics cause sedation, dizziness, and impaired coordination. Patients should be warned to avoid activities that require full alertness, such as driving or operating heavy machinery, after taking the medication to prevent accidents and injuries.
Choice D rationale
Patients should never increase the dose of a prescribed medication without consulting their healthcare provider. Increasing the dose of a hypnotic can lead to increased sedation, potential for overdose, and dependency. The provider needs to assess the patient's response and make any necessary adjustments to the treatment plan.
Correct Answer is B
Explanation
Choice A rationale
Blood glucose levels are not a primary concern for patients taking antithyroid drugs, which are used to treat hyperthyroidism. While thyroid dysfunction can influence blood glucose, monitoring is not a routine part of antithyroid drug therapy. Blood glucose monitoring is essential for patients with diabetes mellitus, which is a separate endocrine disorder from hyperthyroidism.
Choice B rationale
Antithyroid drugs, such as methimazole and propylthiouracil, can cause a serious and rare adverse effect called agranulocytosis, which is a severe reduction in the number of granulocytes, a type of white blood cell. A complete blood count (CBC) is essential to monitor for this life-threatening condition by checking the white blood cell (WBC) count, particularly the neutrophil count. Normal WBC count is 4.5 to 11.0 × 10³ cells/mcL.
Choice C rationale
Serum calcium levels are primarily monitored in conditions related to parathyroid hormone and calcium metabolism, such as hypoparathyroidism or hyperparathyroidism. Antithyroid medications do not directly affect serum calcium levels. Monitoring serum calcium is not a routine part of the management of a patient on antithyroid drugs.
Choice D rationale
The lipid profile, which includes cholesterol and triglycerides, is not routinely monitored for patients on antithyroid drugs. While hyperthyroidism can affect lipid metabolism, antithyroid drugs themselves do not have a significant or primary effect on lipid levels that requires routine monitoring.
Choice E rationale
Serum sodium levels are not a primary concern when a patient is taking antithyroid medications. Hyponatremia or hypernatremia can be caused by various other conditions, such as dehydration, kidney disease, or certain diuretics, but it is not a direct or common side effect of antithyroid drugs.
Choice F rationale
Serum potassium levels are not routinely monitored for patients taking antithyroid drugs. Hyperkalemia or hypokalemia can be caused by various other conditions, such as kidney disease or diuretic use, but it is not a primary or common side effect of antithyroid drugs.
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