# A 50-year-old client with type 2 diabetes and obesity is starting semaglutide 0.25 mg subcutaneous once weekly (titrated). Which teaching is most appropriate? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=375085&lang=en > language: en > subject: Medical Emergencies > category: PA ## Question A 50-year-old client with type 2 diabetes and obesity is starting semaglutide 0.25 mg subcutaneous once weekly (titrated). Which teaching is most appropriate? ## Option 1. Stop the medication immediately if you lose any weight because that means it is working too hard. 2. Inject the same dose at the same time of day, 7 days a week, every day. 3. Use semaglutide as an immediate rescue agent during severe hypoglycemia. 4. Inject once weekly on the same day each week (any time of day, with or without meals); rotate sites (abdomen, thigh, upper arm); expect mild GI side effects (nausea, decreased appetite, diarrhea, constipation) early in titration that usually improve; report severe persistent abdominal pain (possible pancreatitis), neck mass or hoarseness, and avoid the drug if you have a personal or family history of medullary thyroid carcinoma or MEN-2. **✔ Correct answer** **Correct answer: 4** ## Explanation GLP-1 receptor agonists — patient teaching GLP-1 receptor agonists: semaglutide (Ozempic SC weekly·Rybelsus oral daily·Wegovy SC weekly weight loss); liraglutide (Victoza SC daily·Saxenda); dulaglutide (Trulicity SC weekly); exenatide (Byetta·Bydureon); tirzepatide (Mounjaro/Zepbound, dual GIP/GLP-1). Mechanism: increase glucose-dependent insulin secretion, decrease glucagon, slow gastric emptying, increase satiety. Lower BG, weight loss, cardiovascular and renal benefits in T2DM. Key teaching: • Once-weekly SC injection on the same day each week·any time of day·with or without meals·rotate abdomen/thigh/upper arm. • GI side effects:nausea (common), decreased appetite, vomiting, diarrhea, constipation, bloating — peak during titration·usually improve. Eat smaller meals·hydrate·avoid high-fat meals·report severe/persistent. • Pancreatitis warning:severe abdominal pain radiating to back·persistent vomiting → stop·notify provider. • Medullary thyroid carcinoma (MTC) — boxed warning:contraindicated in personal/family history of MTC or MEN-2 (multiple endocrine neoplasia 2)·report neck mass, hoarseness, dysphagia, dyspnea. • Hypoglycemia LOW as monotherapy·increased with insulin/sulfonylurea. • Gallbladder disease·diabetic retinopathy progression (with rapid A1c drop). • Weight loss is an EXPECTED therapeutic effect (positive) — do not stop because of weight loss·titrate per protocol. • Do NOT use for acute hypoglycemia rescue — that is glucagon or D50W. ## In-depth explanation Clinical reasoning summary GLP-1 receptor agonists — patient teaching GLP-1 receptor agonists: semaglutide (Ozempic SC weekly·Rybelsus oral daily·Wegovy SC weekly weight loss); liraglutide (Victoza SC daily·Saxenda); dulaglutide (Trulicity SC weekly); exenatide (Byetta·Bydureon); tirzepatide (Mounjaro/Zepbound, dual GIP/GLP-1). Mechanism: increase glucose-dependent insulin secretion, decrease glucagon, slow gastric emptying, increase satiety. Lower BG, weight loss, cardiovascular and renal benefits in T2DM. Key teaching: • Once-weekly SC injection on the same day each week·any time of day·with or without meals·rotate abdomen/thigh/upper arm. • GI side effects:nausea (common), decreased appetite, vomiting, diarrhea, constipation, bloating — peak during titration·usually improve. Eat smaller meals·hydrate·avoid high-fat meals·report severe/persistent. • Pancreatitis warning:severe abdominal pain radiating to back·persistent vomiting → stop·notify provider. • Medullary thyroid carcinoma (MTC) — boxed warning:contraindicated in personal/family history of MTC or MEN-2 (multiple endocrine neoplasia 2)·report neck mass, hoarseness, dysphagia, dyspnea. • Hypoglycemia LOW as monotherapy·increased with insulin/sulfonylurea. • Gallbladder disease·diabetic retinopathy progression (with rapid A1c drop). • Weight loss is an EXPECTED therapeutic effect (positive) — do not stop because of weight loss·titrate per protocol. • Do NOT use for acute hypoglycemia rescue — that is glucagon or D50W. ## 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=375085&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=375085&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=375085&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=375085&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=375085&lang=vi) --- More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en) _For study reference only. 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