# A 64-year-old client with type 2 diabetes and heart failure with reduced ejection fraction is starting empagliflozin 10 mg orally daily. Which teaching by the nurse is most important?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375084&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A 64-year-old client with type 2 diabetes and heart failure with reduced ejection fraction is starting empagliflozin 10 mg orally daily. Which teaching by the nurse is most important?

## Option

1. Take empagliflozin with your largest meal of the day to prevent low blood sugar; monitor your glucose before meals and at bedtime, and if you notice trembling, sweating, or rapid heartbeat, eat 4 glucose tablets or drink fruit juice—this is important because this drug increases insulin production and commonly causes severe hypoglycemic episodes.
2. Take empagliflozin at bedtime with a small meal containing protein and complex carbohydrates, as this timing reduces the incidence of genital yeast infections and prevents early-morning orthostatic hypotension; avoid taking it upon waking because the medication works best when your body is at rest, and taking it during the day can lead to excessive urination and dehydration during activities.
3. To enhance the blood sugar-lowering effect of empagliflozin, limit your daily fluid intake to no more than 1 liter, because concentrated urine helps the kidneys excrete more glucose; also avoid beverages containing sodium or potassium, weigh yourself daily, and report any weight gain over 2 pounds in a day to your provider.
4. Stop the medication if you become ill with vomiting or are unable to eat solid food and call the provider; otherwise drink fluids regularly, watch for genitourinary infections (yeast or UTI), and seek care for severe nausea, abdominal pain, or rapid breathing because euglycemic diabetic ketoacidosis can occur even when blood glucose is near normal. **✔ Correct answer**

**Correct answer: 4**

## Explanation

SGLT-2 inhibitors — patient teaching
SGLT-2 inhibitors (the gliflozins): empagliflozin (Jardiance), dapagliflozin (Farxiga), canagliflozin (Invokana), ertugliflozin (Steglatro). Block renal glucose reabsorption → glucosuria → glucose lowering, weight loss, BP reduction, cardiovascular and renal benefits in HF and CKD (independent of glucose).

Key teaching priorities:
• Sick-day hold: hold the SGLT-2 during prolonged vomiting, dehydration, hypoxia, planned surgery (3 days before), low oral intake, or any acute illness that could trigger ketoacidosis. Resume only when fully eating/drinking.
• Euglycemic DKA: severe nausea, vomiting, abdominal pain, dyspnea, fatigue — even with normal/low BG; check ketones; emergency evaluation. Mortality risk if missed.
• Genitourinary infections: monilial vaginitis, balanitis, UTI; teach hygiene, hydration, prompt reporting.
• Volume depletion / orthostatic hypotension: maintain adequate hydration; watch in elderly, diuretic users.
• Fournier gangrene (rare): severe perineal pain, swelling, fever — emergency.
• Lower-limb amputation (canagliflozin signal — historical; updated data): monitor foot care.
• Hypoglycemia risk LOW as monotherapy; risk increases with insulin or sulfonylurea co-prescription.
• Renal limits: dapagliflozin/empagliflozin generally allowed down to eGFR 20-25 for HF/CKD benefit; do not start in advanced CKD outside specific approvals.
• Strong CV/renal benefits in HFrEF and CKD — class is now recommended even without diabetes for these indications.

## In-depth explanation

Clinical reasoning summary
SGLT-2 inhibitors — patient teaching
SGLT-2 inhibitors (the gliflozins): empagliflozin (Jardiance), dapagliflozin (Farxiga), canagliflozin (Invokana), ertugliflozin (Steglatro). Block renal glucose reabsorption → glucosuria → glucose lowering, weight loss, BP reduction, cardiovascular and renal benefits in HF and CKD (independent of glucose).

Key teaching priorities:
• Sick-day hold: hold the SGLT-2 during prolonged vomiting, dehydration, hypoxia, planned surgery (3 days before), low oral intake, or any acute illness that could trigger ketoacidosis. Resume only when fully eating/drinking.
• Euglycemic DKA: severe nausea, vomiting, abdominal pain, dyspnea, fatigue — even with normal/low BG; check ketones; emergency evaluation. Mortality risk if missed.
• Genitourinary infections: monilial vaginitis, balanitis, UTI; teach hygiene, hydration, prompt reporting.
• Volume depletion / orthostatic hypotension: maintain adequate hydration; watch in elderly, diuretic users.
• Fournier gangrene (rare): severe perineal pain, swelling, fever — emergency.
• Lower-limb amputation (canagliflozin signal — historical; updated data): monitor foot care.
• Hypoglycemia risk LOW as monotherapy; risk increases with insulin or sulfonylurea co-prescription.
• Renal limits: dapagliflozin/empagliflozin generally allowed down to eGFR 20-25 for HF/CKD benefit; do not start in advanced CKD outside specific approvals.
• Strong CV/renal benefits in HFrEF and CKD — class is now recommended even without diabetes for these indications.

## Related questions

- [A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, swea…](https://mymerci.kr/pages/nclex_q.php?qn_id=360524&lang=en)
- [A 68-year-old client with COPD is admitted with shortness of breath and SpO2 86% on room a…](https://mymerci.kr/pages/nclex_q.php?qn_id=362940&lang=en)
- [A 58-year-old client arrives at the emergency department with crushing substernal chest pa…](https://mymerci.kr/pages/nclex_q.php?qn_id=362976&lang=en)
- [A 72-year-old client is brought to the emergency department by family who report that the …](https://mymerci.kr/pages/nclex_q.php?qn_id=363003&lang=en)
- [A 79-year-old client is admitted from a long-term care facility with diarrhea, decreased o…](https://mymerci.kr/pages/nclex_q.php?qn_id=363089&lang=en)
- [A 76-year-old female with chronic heart failure and atrial fibrillation receives digoxin 0…](https://mymerci.kr/pages/nclex_q.php?qn_id=374883&lang=en)
- [A 70-year-old client on long-term digoxin therapy reports new yellow-green halos around li…](https://mymerci.kr/pages/nclex_q.php?qn_id=374884&lang=en)
- [A 58-year-old client with type 2 diabetes mellitus and migraine prophylaxis is taking prop…](https://mymerci.kr/pages/nclex_q.php?qn_id=374893&lang=en)

## Read in another language

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=375084&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=375084&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=375084&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=375084&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=375084&lang=vi)

---

More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en)

_For study reference only. Always follow current clinical guidelines and your institution’s protocols._