Diabetes Mellitus Q 57 - Gyan Darpan : Learning Portal
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Thursday 7 April 2022

Diabetes Mellitus Q 57

Serge who has diabetes mellitus is taking oral agents and is scheduled for a diagnostic test that requires him to be NPO. What is the best plan of the nurse with regard to giving the client his oral medications?
    A. Administer the oral agents immediately after the test.
    B. Notify the diagnostic department and request orders.
    C. Notify the physician and request orders.
    D. Administer the oral agents with a sip of water before the test.

Correct Answer: C. Notify the physician and request orders.

It is best to notify the client’s physician and request orders. After a period of fasting (“nil per os,” NPO), oral antidiabetic drugs should be resumed only when the patient eats the first normal-sized meal. Special recommendations are in effect for metformin and sulfonylureas.

Option A: The medications should not be given upon return unless the physician orders this; the client may still need to be NPO. Metformin, according to the manufacturer’s instructions, should be stopped 48 hours before the intended procedure and resumed only when the patient is reliably tolerating oral food intake, as long as there are no other contraindications
Option B: The radiologist in the diagnostic department might give orders, but it would be best to check with the client’s physician first. As the use of iodinated radiological contrast media can temporarily lower the glomerular filtration rate, potentially inducing renal failure, metformin should be discontinued at least 24 hours before the radiological study and restarted no sooner than 48 hours afterward, and only if laboratory tests confirm normal renal function.
Option D: The client should not receive the medication during NPO status unless directed by the physician. When oral antidiabetic agents are temporarily discontinued, insulin can be given: the blood glucose concentration can be controlled either with subcutaneous insulin injections or with intravenous insulin through a perfusor pump, depending on the length and invasiveness of the procedure.

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