The nurse is providing education to a patient about a low-fat diet. The nurse suspects the patient needs additional education when he states:

Choice A reason: Metformin reduces blood sugar primarily by inhibiting hepatic gluconeogenesis, decreasing liver glucose production. It also enhances insulin sensitivity in peripheral tissues, reducing hyperglycemia in type 2 diabetes without causing hypoglycemia, as it does not stimulate insulin secretion, making this the accurate mechanism.

Choice B reason: Metformin does not block carbohydrate absorption in the intestine. Drugs like alpha-glucosidase inhibitors (e.g., acarbose) slow carbohydrate breakdown, but metformin primarily acts on the liver to reduce gluconeogenesis and improve insulin sensitivity, not directly affecting intestinal absorption.

Choice C reason: Metformin does not stimulate insulin release from the pancreas. This is the mechanism of sulfonylureas, which enhance beta-cell insulin secretion. Metformin works by reducing hepatic glucose output and increasing insulin sensitivity, making this statement incorrect for its mechanism of action.

Choice D reason: Metformin decreases, not increases, insulin resistance. It enhances insulin sensitivity in muscle and liver cells, improving glucose uptake and utilization. Increasing insulin resistance would worsen type 2 diabetes, making this statement incorrect, as metformin’s goal is to counteract insulin resistance.

Choice A reason: Oral analgesics are less effective in acute pancreatitis due to severe pain and potential gastric dysmotility from inflammation. IV opioids provide faster, more reliable pain relief, as oral absorption may be impaired, making this a less appropriate choice for acute pain management.

Choice B reason: A high-fiber diet is contraindicated in acute pancreatitis, as it stimulates digestion, increasing pancreatic enzyme secretion and worsening inflammation and pain. Patients are typically kept NPO (nothing by mouth) to rest the pancreas, making this an inappropriate intervention for pain control.

Choice C reason: IV opioid analgesics, such as morphine or fentanyl, are the preferred treatment for severe pain in acute pancreatitis. They provide rapid, effective analgesia by acting on central pain receptors, reducing discomfort without stimulating pancreatic activity, making this the priority intervention for pain management.

Choice D reason: Applying a warm compress to the abdomen is contraindicated, as heat may increase inflammation and blood flow to the pancreas, worsening pain and tissue damage. Pain management in pancreatitis relies on pharmacological interventions, making this an incorrect and potentially harmful action.