The nurse is caring for a client with type 2 diabetes mellitus who is taking liraglutide. Which problem(s) in the client's history may increase the risk for development of pancreatitis? Select all that apply.

High triglyceride levels.

Chronic alcohol use.

Gallstones.

Moderate daily alcohol use.

Pancreatitis.

Answer and Explanation

Correct Answer : A,B,C,E

Rationale:
A. High triglyceride levels: Elevated triglycerides are a major risk factor for pancreatitis because they can cause pancreatic inflammation by leading to the accumulation of free fatty acids that injure pancreatic tissue. Clients with uncontrolled lipid levels require close monitoring while on medications like liraglutide.

B. Chronic alcohol use: Long-term alcohol consumption damages the pancreas directly by promoting inflammation and fibrosis, significantly increasing the risk of pancreatitis. Chronic use compounds the pancreatitis risk when the client is also taking medications like liraglutide that carry a pancreatic warning.

C. Gallstones: Gallstones can obstruct the pancreatic duct, leading to the backflow of digestive enzymes and resulting in pancreatic inflammation. A history of gallstones makes the client particularly vulnerable to developing pancreatitis while on incretin-based therapies like liraglutide.

D. Moderate daily alcohol use: Moderate alcohol intake is less strongly associated with pancreatitis compared to heavy or chronic use. Although any alcohol use can pose some risk, moderate consumption alone is generally not considered a primary risk factor for drug-induced pancreatitis.

E. Pancreatitis: A personal history of pancreatitis indicates previous pancreatic injury, making the pancreas more susceptible to future episodes. Starting liraglutide in someone with a history of pancreatitis requires extreme caution due to the increased likelihood of recurrence.

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Correct Answer is B

Explanation

A. Do you perform regular testicular self-examinations?: While important for early detection of testicular cancer, this question does not directly address the concern about testicular shrinkage, which is more likely linked to hormonal influences or substance use.

B. Are you taking any type of anabolic steroids?: Anabolic steroid use can suppress natural testosterone production, leading to testicular atrophy or shrinkage. Identifying steroid use is critical because it directly relates to the reported symptom and can have significant long-term health consequences.

C. Do you use any type of herbal supplements?: Herbal supplements can sometimes affect hormone levels, but they are far less likely than anabolic steroids to cause noticeable testicular shrinkage.

D. How many hours a day do you spend exercising?: While excessive exercise can impact overall hormonal balance, it is unlikely by itself to cause significant testicular shrinkage. Directly investigating anabolic steroid use is a much higher priority based on the symptom described.

A. Notify the healthcare provider if anorexia occurs. B. Consume additional sources of potassium. C. Watch for signs of jitteriness or diaphoresis. D. Administer subcutaneously after meals.

Correct Answer is C

Explanation

A. Notify the healthcare provider if anorexia occurs: Anorexia can be a side effect of exenatide, but it is generally mild and often transient. While persistent or severe anorexia should be reported, it is not the most immediate or dangerous concern compared to the risk of hypoglycemia when combining exenatide with a sulfonylurea like glimepiride.

B. Consume additional sources of potassium: Exenatide is not known to cause significant potassium depletion. Hypokalemia is not a common complication with either exenatide or glimepiride therapy, so there is no specific need to focus on increasing potassium intake.

C. Watch for signs of jitteriness or diaphoresis: Combining exenatide with glimepiride significantly increases the risk of hypoglycemia. Symptoms like jitteriness, diaphoresis, shakiness, and confusion are hallmark signs of low blood sugar, making it crucial to educate the client to recognize and manage hypoglycemia promptly.

D. Administer subcutaneously after meals: Exenatide should be administered subcutaneously, but it must be given before meals, typically within 60 minutes prior to eating. Administering it after meals would decrease its effectiveness in controlling postprandial blood glucose spikes.

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The nurse is caring for a client with type 2 diabetes mellitus who is taking liraglutide. Which problem(s) in the client's history may increase the risk for development of pancreatitis? Select all that apply.

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