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. Print an electrocardiogram strip B. Call for rapid response C. Perform chest compressions D. Apply oxygen via nasal cannula E. Give naloxone 2 mg intravenous push F. Provide rescue breaths with a manual ventilation bag

Correct Answer is ["B","E","F"]

Explanation

A. Print an electrocardiogram strip: While cardiac monitoring is important, printing an ECG strip does not immediately address the critical issue of respiratory depression and unresponsiveness. Priority actions must focus on airway and breathing first.

B. Call for rapid response: The client is critically unstable with severe respiratory depression and unresponsiveness, meeting criteria for a rapid response or even a code blue if the situation deteriorates further. Immediate expert team support is crucial.

C. Perform chest compressions: Chest compressions are only indicated if the client is pulseless. In this case, the client has a heart rate of 92 beats/minute, meaning compressions are not appropriate at this moment.

D. Apply oxygen via nasal cannula: A nasal cannula would not deliver high enough oxygen concentrations for someone with a respiratory rate of 5 breaths/minute and oxygen saturation of 54%. Higher oxygen delivery methods and ventilatory support are urgently needed.

E. Give naloxone 2 mg intravenous push: Naloxone is indicated immediately to reverse opioid-induced respiratory depression. Giving the prescribed naloxone IV push can rapidly counteract the morphine overdose and improve the client’s respiratory effort.

F. Provide rescue breaths with a manual ventilation bag: Because the client’s respirations are critically low, rescue breathing with a manual resuscitation bag is necessary to maintain oxygenation and ventilation until naloxone takes effect or more advanced airway management is available.

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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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