Question: The nurse provides discharge instructions for a client beginning oral hypoglycemic therapy. Which statements if made by the client indicate a need for further instructions? Select all that apply.
1. “If I am ill, I should skip my daily dose.”
2. “If I overeat, I will double my dosage of medication.”
3. “Oral agents are effective in managing Type 2 diabetes.”
4. “If I become pregnant I will discontinue my medication.”
5. “Oral hypoglycemic medications will cause my urine to turn orange.”
6. “My medications are used to manage my diabetes along with diet and exercise.”
Rationale: Clients are instructed that oral agents are used in addition to diet and exercise as therapy for diabetes. During illness or periods of intense stress, the client should be instructed to monitor his or her blood glucose level frequently and should contact the health care provider if the blood glucose is elevated because insulin may be needed to prevent acute hyperglycemia symptoms. The medication should not be skipped or the dosage should not be doubled. Taking extra pills should be avoided unless specifically prescribed by the health care provider. These medications do not change the color of the urine. Medication should never be discontinued unless instructed to do so by the health care provider. However, the diabetic who becomes pregnant will need to contact her health care provider because the oral diabetic medication may have to be changed to insulin therapy because oral hypoglycemics can be harmful to the fetus.
Priority Nursing Tip: Any changes to prescribed medication usage or amounts should not be made by clients without prior physician approval.
Test-Taking Strategy: Note the strategic words “need for further instructions.” These words indicate a negative event query and the need to select the incorrect options. Think about the pathophysiology of diabetes mellitus and its treatment and use general medication guidelines to answer correctly. Review the characteristics of oral hypoglycemics if you had difficulty with this question.
Level of Cognitive Ability: Evaluating
Client Needs: Physiological Integrity
Integrated Process: Teaching and Learning
Content: Adult Health/Endocrine
References: Lewis, S., Heitkemper, M., Dirksen, S., O’Brien, P., & Bucher, L. (2007). Medical-surgical nursing: Assessment and management of clinical problems (7th ed., p. 1275). St. Louis: Mosby.
Potter, P., & Perry, A. (2009). Fundamentals of nursing (7th ed., pp. 710–712). St. Louis: Mosby.
This week’s NCLEX exam practice question came from:
Silvestri: Saunders Q&A Review for the NCLEX-RN Exam, 5th Edition, Test 1, Page 123, Question 205
Thank you very much for sharing these informative and wonderful strategies.
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