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A client with type 2 diabetes mellitus (DM) who normally takes an oral antidiabetic agent asks the nurse why insulin is necessary during this hospitalization for chronic obstructive pulmonary disease (COPD) exacerbation and pneumonia. Review of the medication record indicates the client is taking methylprednisolone, clindamycin, and pioglitazone. How should the nurse respond?

A.

"Antibiotics cause significant fluctuations in blood glucose, which are controlled with insulin."

B.

"The infection and the steroid medications you are taking can increase your blood sugar."

C.

"You may need to take insulin when you go home since your oral agent is no longer sufficient."

D.

"The use of insulin is easier to control your blood sugars while you are hospitalized."

Answer and Explanation

The Correct Answer is B

Rationale:

 

A. While antibiotics can influence blood glucose, the primary reason for insulin in this context is the effect of steroids and infection on blood glucose levels.

 

B. Methylprednisolone, a steroid, can increase blood glucose levels, necessitating the use of insulin to manage elevated glucose levels during illness.

 

C. The need for insulin is related to the current hospitalization and medication effects, not necessarily a long-term change in diabetes management.

 

D. The ease of control is less relevant compared to the fact that steroids and infection can significantly impact blood glucose levels, necessitating insulin during hospitalization.


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View Related questions

Correct Answer is A

Explanation

Rationale:

A.Dopamine, a sympathomimetic agent, can cause significant changes in blood pressure. Monitoring blood pressure every 15 minutes is crucial to assess the client's response to the medication and to detect any adverse effects, such as hypertension or hypotension, promptly.


B.Monitoring CBC is important but not as immediately critical in this situation as monitoring blood pressure.


C.While reviewing creatinine and BUN results is important for overall kidney function, it is not the most immediate priority when administering dopamine for shock.


D. Measuring urinary output is important for assessing renal perfusion but should be done more frequently than daily in a client receiving dopamine for shock.

Correct Answer is C

Explanation

Rationale:

A. The history of coronary artery bypass surgery is important but does not directly relate to the current symptoms.

B. A recent colonoscopy is not relevant to the client's current symptoms.

C. Long-term use of digoxin and furosemide is highly significant as these medications can lead to digoxin toxicity, especially in the context of dehydration or renal insufficiency. Symptoms like nausea, vomiting, and anorexia are classic signs of digoxin toxicity.

D. A history of depression is important but not immediately relevant to the current symptoms of nausea, vomiting, and anorexia.

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