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NCLEX QUESTIONS DIABETES TYPE 2A nurse is participating in a diabetes screening program. Who of the following is (are) at risk for developing type 2 diabetes? Select all that apply.A 32 year-old female who delivered a 9 ? -lb infant.A 44 year-old Native American (First Nations) who has a body mass index (BMI) of 32.An 18 year-old immigrant from Mexico who jogs four times a week.A 55 year-old Asian who has hypertension and two siblings with type 2 diabetes.A 12 year-old who is overweight. Answer: a, b, d, eRationale: The risk factors for developing type 2 diabetes include giving birth to an infant weighing over 9 lb; obesity (BMI over 30); ethnicity of Asian, African, Native American, or First Nations; age greater than 45 years; hypertension; and family history in parents or siblings. Childhood obesity is also a risk factor for type 2 diabetes. Maintaining an ideal weight, eating a low-fat diet, and exercising regularly decrease the risk of type 2 diabetes. An adult with type 2 diabetes is taking metformin (Glucophage) 1,000 mg two times every day. After the nurse provides the instructions regarding the interaction of alcohol and metformin, the nurse evaluates that the client understands the instructions when the client says:“If I know I’ll be having alcohol, I must not take metformin; I could develop lactic acidosis.”“If my physician approves, I may drink alcohol with my metformin.”“Adverse effects I should watch for are feeling excessively energetic, unusual muscle stiffness, low back pain, and a rapid heartbeat.”“If I feel bloated, I should call my physician.”Answer: aRationale: A rare but serious adverse effect of metformin (Glucophage) is lactic acidosis; half the cases are fatal. Ideally, one should stop metformin for 2 days before and 2 days after drinking alcohol. Signs and symptoms of lactic acidosis are weakness, fatigue, unusual muscle pain, dyspnea, unusual stomach discomfort, dizziness or light-headedness, and bradycardia or cardiac arrhythmias. Bloating is not an adverse effect of metformin. The client has been recently diagnosed with type 2 diabetes and is taking metformin (Glucophage) two times per day 1,000 mg before breakfast and 1,000 mg before supper. The client is experiencing diarrhea, nausea, vommitimg, abdominal bloating, and anorexia on admission to the hospital. The admissionprescriptions include metformin (Glucophage). The nurse should do which of the following? Select all that apply.Discontinue the metformin (Glucophage).Administer glargine (Lantus) insulin rather than the metformin (Glucophage).Inform the client that adverse effects of diarrhea, nausea, and upset stomach gradually subside over time.Assess the client’s renal function.Monitor the client’s glucose value prior to each meal.Answer: c, d, eRationale: The nurse may not discontinue a medication without a physician’s prescription, and the nurse may not substitute one medication for another. Maximum doses may be better tolerated if given with meals. Before therapy begins, and at least annually thereafter, assess the client’s renal function; if renal impairment is detected, a different antidiabetic agent may be indicated. To evaluate the effectiveness of therapy, the client’s glucose value must be monitored regularly. The prescriber must be notified if the glucose value increases, despite therapy.When talking with a patient who is about to begin repaglinide (Prandin) therapy to treat type 2 diabetes mellitus, the health care professional should include which of the following instructions?Do not drink more than 1 L of grapefruit juice per day.Carry a high-protein snack at all times.Drink 16 oz of water after taking the drug.Use ginseng to reduce nausea.Answer: aRationale: More than 1 L of grapefruit juice per day can increase the hypoglycemic effects of repaglinide, a meglitinide. The health care professional should tell the patient to avoid drinking large amounts of grapefruit juice.A health care professional is caring for a patient who is about to begin taking pioglitazone (Actos) to treat type 2 diabetes mellitus. The health care professional should explain to the patient the need to monitor which of the following laboratory tests?Thyroid-stimulating hormone (TSH)Alanine aminotransferase (ALT) and LDLComplete blood count (CBC)Creatinine clearanceAnswer: bRationale: Pioglitazone can cause liver injury. The health care professional should monitor ALT at the start of therapy and every 3 to 6 months thereafter. The health care professional should tell the patient to report jaundice, dark-colored urine, or abdominal pain. Pioglitazone can cause elevations in both high- density lipoproteins, which is a beneficial effect, and LDLs, which is a detrimental effect. The health care professional should monitor the patient’s plasma lipid levels at baseline and periodically throughout drug therapy.A health care professional is caring for a patient who is taking repaglinide (Prandin) 15 to 30 minutes before each meal to treat type 2 diabetes mellitus. The patient asks the health care professional what to do if he skips a meal. Which of the following is the appropriate response?Double the dose before the next meal.Take half the dose.Skip the dose.Take the usual dose.Answer: cRationale: To avoid a sudden and serious drop in blood glucose level, the patient should skip the dose of repaglinide, a meglitinide, whenever he skips a meal, and try to avoid skipping meals.A patient who is taking metformin (Glucophage) to treat type 2 diabetes mellitus plans to undergo angiography using iodine-containing contrast dye. The health care professional should recognize that an interaction between metformin and the IV contrast dye can increase the patient’s risk for which of the following?HypokalemiaHyperglycemiaAcute renal failureAcute pancreatitisAnswer: cRationale: Metformin, a biguanide, can interact with iodine-containing contrast dye, causing acute renal failure and lactic acidosis. The health care professional should withhold metformin for 48 hours prior to and following the procedure. The health care professional should also monitor the patient for indications of acute renal failure or lactic acidosis, such as reduced urine output, hyperventilation, and abdominal pain. A patient who is taking glipizide (Glucotrol) to treat type 2 diabetes mellitus contacts the health care professional to report feeling shaky, hungry, and fatigued. The health care professional should tell the patient to do which of the following?Drink 16 oz of water.Perform a fingerstick blood glucose.Take another glipizide tablet.Lie down and rest.Answer: bRationale: Glipizide, a sulfonylurea, can cause hypoglycemia, which can manifest as diaphoresis, shakiness, hunger, and fatigue. The health care professional should tell the patient to check her blood glucose level, and if it indicates hypoglycemia, consume a snack of 15 to 20 g of carbohydrates, retest in 15 to 20 minutes, and repeat if her blood glucose level is still low. A health care professional is caring for a patient who is about to begin acarbose (Precose) therapy to treat type 2 diabetes mellitus. Which of the following instructions should the health care professional include when talking with the patient about the drug?Eat more iron-rich foods.Avoid drinking grapefruit juice.Increase fiber intake.Avoid drinking green tea.Answer: Acarbose, an alpha-glucosidase inhibitor, can cause iron-deficiency anemia. The health care professional should tell the patient to increase his intake of iron-rich foods, such as red meat, spinach, and grains, and monitor the patient’s CBC.A patient who is newly diagnosed with type two diabetes mellitus is prescribed sitagliptin (Januvia). The normal PO dose for adults is 100 mg once daily. The patient was given 50 mg tablets. How many tablets would the patient take?1 tablet.2 tablets.3 tablets.4 tablets.Answer: bRationale: If the normal PO adult does is 100 mg once daily and the patient is given 50 mg tablets, the patient would take 2 50 mg tablets to equal 100 mg.50 mg x 2 tablets = 100 mg References:Billings, D. M., & Hensel, D. “Lippincott Q&A Review for NCLEX-RN” (2015). (11th ed.). Wolters Kluwer Health, Lippincott & Wilkins.(n.d.). Retrieved March 01, 2016, from ................
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