Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2Is)

Every question here, with the answer

1. A client with heart failure is to receive the first dose of dapagliflozin. The nurse notes sunken eyes, skin tenting, and a rapid heart rate. What should the nurse do?

   1. Give the dose at bedtime instead.
   2. Give the dose with an extra glass of water.
   3. Notify the provider before giving the drug.
   4. Give the dose and recheck vital signs in four hours.

   Answer: Notify the provider before giving the drug.

   Volume status must be assessed before starting an SGLT2I, and the nurse notifies the provider if signs of dehydration are present, because low fluid volume can cause significant hypotension. Giving the dose in any form ignores that risk.

2. A client without diabetes asks why empagliflozin, "a diabetes pill," was prescribed for heart failure. What is the nurse's best response?

   1. "It is only used because you are at risk of diabetes."
   2. "It raises your blood glucose to give the heart more energy."
   3. "It was prescribed by mistake and should be held."
   4. "These drugs were found to reduce mortality in heart failure, whether or not a person has diabetes."

   Answer: "These drugs were found to reduce mortality in heart failure, whether or not a person has diabetes."

   SGLT2Is were studied for all clients with heart failure regardless of diabetes and were found to reduce mortality. The other options misstate the reason or the drug's effect on glucose.

3. Which adverse effects should the nurse monitor for in a client taking an SGLT2I? Select all that apply.

   1. Hyperkalemia from potassium retention
   2. Volume depletion and hypotension
   3. Urinary tract infection
   4. Genital infection
   5. Bradycardia

   Answer: Volume depletion and hypotension, Urinary tract infection, Genital infection

   The section lists urinary tract infection, genital infection, volume depletion and hypotension among SGLT2I adverse effects. Hyperkalemia and bradycardia are not listed as adverse effects of this class.

4. A client with type 2 diabetes who uses insulin is starting dapagliflozin for heart failure. What should the nurse teach?

   1. "Double your insulin to prevent high blood sugar."
   2. "Tell your provider that you take insulin, because both drugs lower blood glucose and a dose may need to be lowered."
   3. "Stop your insulin once you start this drug."
   4. "These drugs do not affect each other."

   Answer: "Tell your provider that you take insulin, because both drugs lower blood glucose and a dose may need to be lowered."

   Both insulin and SGLT2Is lower blood glucose, so the client informs the provider and may be prescribed a lower dose of either drug. Stopping or doubling insulin on one's own, or ignoring the interaction, is not supported.

5. Before starting an SGLT2I, which findings would the nurse report to the provider as possible contraindications? Select all that apply.

   1. History of type 2 diabetes
   2. Previous serious hypersensitivity reaction to dapagliflozin
   3. Acute kidney disease
   4. History of heart failure
   5. The client is pregnant

   Answer: Previous serious hypersensitivity reaction to dapagliflozin, Acute kidney disease, The client is pregnant

   Kidney disease, pregnancy, and a history of serious hypersensitivity to dapagliflozin are listed contraindications. Type 2 diabetes and heart failure are indications for the drug, not contraindications.

6. A client taking empagliflozin calls to report dry mouth and lightheadedness when standing. The nurse recognizes that this client is most at risk for which problem?

   1. Significant hypotension from low fluid volume
   2. Fluid overload
   3. Hyperkalemia
   4. Hypertensive crisis

   Answer: Significant hypotension from low fluid volume

   Dry mouth and lightheadedness are signs of dehydration, and SGLT2Is can cause significant hypotension in the presence of hypovolemia. The drug promotes diuresis, so fluid overload and hypertensive crisis do not fit.