Author Question: A patient with type I diabetes is taking NPH insulin, 30 units every day. A nurse notes that the ... (Read 13 times)

justinmsk · **on:** Jul 23, 2018

A patient with type I diabetes is taking NPH insulin, 30 units every day. A nurse notes that the patient is also taking metoprolol (Lopressor). What education should the nurse provide to the patient?

a. Metoprolol has no effect on diabetes mellitus or on your insulin requirements.
b. Metoprolol interferes with the effects of insulin, so you may need to increase your insulin dose.
c. Metoprolol may mask signs of hypoglycemia, so you need to monitor your blood glucose closely.
d. Metoprolol may potentiate the effects of the insulin, so the dose should be reduced.

Question 2

A patient with pheochromocytoma is admitted for surgery. The surgeon has ordered an alpha-blocking agent to be given preoperatively. What does the nurse understand about this agent?

a. It is ordered to prevent perioperative hypertensive crisis.
b. It prevents secretion of catecholamines by the adrenal tumor.
c. It reduces contraction of smooth muscles in the adrenal medulla.
d. It is given chronically after the surgery to prevent hypertension.

Chelseyj.hasty · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

ANS: C
Because metoprolol may mask the signs of hypoglycemia, the patient should monitor the blood glucose closely and report changes to the prescriber. Metoprolol does have an indirect effect on diabetes mellitus and/or insulin requirements in that it may mask the signs of hypoglycemia, causing the patient to make a healthcare decision based on the drug-to-drug interaction rather than actual physiologic factors. The patient should not increase the insulin, because metoprolol will cause a decrease in blood glucose, increasing the risk of a hypoglycemic reaction. The patient should not reduce the dose of insulin when taking metoprolol, because this might alter serum glucose levels.

Answer to Question 2

ANS: A
Manipulation of the adrenal tumor in patients with pheochromocytoma can cause a massive catecholamine release. Alpha-adrenergic antagonists are given to reduce the risk of acute hypertension during surgery. These agents do not prevent secretion of catecholamines; they block catecholamine receptor sites. They do not act on the tissue of the adrenal medulla. They are given chronically in patients who have inoperable tumors.