Nursing Video Notes - Priority Interventions, Diabetes Medications, Lab Monitoring, and Hormone Replacement

Page 1

• Question: A nurse is caring for a client on a medical-surgical unit. Which of the following interventions are priority for the nurse to make? Select all that apply.
  • A) 50\%\ \text{dextrose in water} IV
  • B) Check blood glucose in 15\ \text{min}
  • C) Give 4\ \text{oz} orange juice
  • D) Give glucagon subcutaneously
  • E) Turn client on their side
• Answer: A, B
• Rationale:
  • In suspected hypoglycemia, the priority is to restore circulating glucose quickly and confirm the glucose level.
  • Administering 50\%\ dextrose in water IV (A) rapidly increases blood glucose, which is essential in conscious or semi-conscious patients with hypoglycemia when IV access is available.
  • Checking blood glucose in 15\ \text{min} (B) provides a rapid assessment of treatment effectiveness and guides further action.
  • Giving orange juice (C) is a potential option for mild hypoglycemia in a conscious patient, but is not the primary priority when IV dextrose is available.
  • Glucagon (D) is an alternative if IV access is not available or if IV dextrose cannot be given.
  • Turning the client on their side (E) is an indication to prevent aspiration if the patient is vomiting or has reduced consciousness, but is not the immediate priority for correcting hypoglycemia.
• Key concepts:
  • Hypoglycemia management prioritizes rapid glucose restoration and monitoring response.
  • Dextrose IV is preferred when possible; glucagon is a backup when IV access is unavailable.
  • Side-lying position is an airway-protection measure, not a primary treatment for hypoglycemia.

Page 2

• Question: A nurse is planning care for a client on a medical-surgical unit. Which of the following actions should the nurse plan to take? Select all that apply.
  • A) Give glargine insulin in the morning
  • B) Give lispro insulin 15 min before meals
  • C) Inject medications in the abdomen
• Answer: A, B, C
• Rationale:
  • Glargine insulin is a long-acting (basal) insulin often given in the morning or at a consistent time daily to provide baseline insulin coverage.
  • Lispro insulin is a rapid-acting insulin given about 15\ \text{min} before meals to manage postprandial glucose rise.
  • Abdominal injection sites are common due to rapid and consistent absorption; however, sites should be rotated to prevent lipodystrophy and absorption variability.
• Key concepts:
  • Basal-bolus insulin regimen typically includes a long-acting insulin (e.g., glargine) and a rapid-acting insulin (e.g., lispro) before meals.
  • Injection site selection and rotation are important for predictable absorption and to avoid tissue changes.

Page 3

• Question: A nurse is caring for a client who is taking pioglitazone to treat type 2 diabetes mellitus. The nurse should monitor for which of the following findings?
  • Weight gain
• Answer: Weight gain
• Rationale:
  • Pioglitazone is a thiazolidinedione (TZD) that can cause fluid retention and weight gain due to increased adiposity and edema.
  • Other potential adverse effects include edema, heart failure risk in susceptible patients, and hepatotoxicity; but weight gain is specifically noted as a finding to monitor.
• Key concepts:
  • TZDs can cause edema and weight gain; monitor body weight and signs of fluid overload.
  • Be alert for heart failure symptoms and hepatic dysfunction when using pioglitazone.

Page 4

• Question: A nurse is caring for a client who is about to begin taking pioglitazone to treat type 2 diabetes mellitus. The nurse should explain to the client about the need to monitor which of the following laboratory values?
  • A) Alanine aminotransferase (ALT)
  • B) Low-density lipoproteins (LDL)
• Answer: ALT (with consideration of lipid monitoring)
• Rationale:
  • ALT monitoring is essential because pioglitazone can cause hepatotoxicity; baseline liver enzymes should be obtained before starting therapy and monitored periodically.
  • Lipid levels (LDL) may also be affected by TZDs; a lipid panel can be part of routine monitoring to assess dyslipidemia risk, since pioglitazone can influence lipid metabolism.
  • Guideline approach: obtain baseline LFTs (including ALT) and a lipid panel; monitor ALT during therapy; discontinue pioglitazone if ALT rises significantly (e.g., >3× ULN in some guidelines).
• Additional note (formula for emphasis):
  • If ALT > 3\times \text{ULN}, consider discontinuation of pioglitazone and evaluate for hepatotoxicity.
• Key concepts:
  • Hepatic safety is a priority when starting pioglitazone; monitor ALT/LFTs.
  • Lipid profile changes may occur; monitor LDL as part of metabolic risk assessment while on TZDs.

Page 5

• Question: When considering replacement therapy options for a client who has chronic adrenocortical insufficiency, a nurse should recognize that the provider will choose which of the following medications?
  • Hydrocortisone
• Answer: Hydrocortisone
• Rationale:
  • For chronic adrenocortical insufficiency (e.g., Addison’s disease), glucocorticoid replacement is essential; hydrocortisone is the preferred first-line glucocorticoid due to its glucocorticoid and mineralocorticoid activity balance and physiologic cortisol replacement.
  • Depending on the degree of insufficiency, mineralocorticoid replacement (e.g., fludrocortisone) may also be required to maintain electrolyte balance and blood pressure.
  • Practical implications: dosing should mimic diurnal cortisol rhythm; adjust dosing during stress/illness; educate on signs of under- and over-replacement and the need for medical coordination during illness.
• Key concepts:
  • Hydrocortisone is the standard replacement therapy for chronic adrenocortical insufficiency.
  • Consideration of mineralocorticoid replacement and stress-dose adjustments are part of comprehensive management.
• Ethical/practical implications:
  • Lifelong medication adherence and education are critical for preserving quality of life and preventing adrenal crisis.
• Summary of connections:
  • Across pages, patient safety in acute hypoglycemia, diabetes pharmacotherapy (basal-bolus insulin and TZD monitoring), and endocrine replacement therapy illustrate the need for careful monitoring, timely interventions, and patient education to optimize outcomes.