A client who has diabetes mellitus is scheduled for a colonoscopy. The nurse instructs the client to stop taking metformin 48 hours before and after the procedure.

What is the rationale for this instruction?

To prevent hypoglycemia during fasting

To prevent lactic acidosis due to contrast dye

To prevent hyperglycemia due to stress response

To prevent nephrotoxicity due to dehydration

Answer and Explanation

The Correct Answer is B

To prevent lactic acidosis due to contrast dye

Rationale: Metformin is an oral antidiabetic agent that lowers blood glucose levels by decreasing hepatic glucose production and increasing peripheral glucose uptake. However, metformin can cause lactic acidosis, a rare but serious condition that occurs when lactate accumulates in the blood faster than it can be metabolized. Lactic acidosis can be triggered by contrast dye used for radiographic procedures, such as colonoscopy, especially in clients who have renal impairment or dehydration. Therefore, metformin should be discontinued 48 hours before and after any procedure that involves contrast dye.

Incorrect options:

A) To prevent hypoglycemia during fasting - This is not the rationale for discontinuing metformin, as metformin does not cause hypoglycemia by itself. However, the client may need to adjust the dose of other antidiabetic medications or insulin to prevent hypoglycemia during fasting.

C) To prevent hyperglycemia due to stress response - This is not the rationale for discontinuing metformin, as metformin does not cause hyperglycemia by itself. However, the client may need to monitor blood glucose levels more frequently and report any signs of hyperglycemia to the provider.

D) To prevent nephrotoxicity due to dehydration - This is not the rationale for discontinuing metformin, as metformin does not cause nephrotoxicity by itself. However, the client should be advised to maintain adequate hydration before and after the procedure to prevent dehydration and renal impairment.

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Correct Answer is A

Explanation

Repeat back the order to the physician verbatim.

Rationale: The nurse should repeat back the order to the physician verbatim, as this is a standard practice to verify the accuracy and completeness of the order. Repeating back the order allows the nurse and the physician to check for any errors, omissions, or ambiguities, and to clarify any questions or concerns.

Incorrect options:

B) Ask another nurse to listen to the order on speakerphone. - This is not an appropriate action, as it violates the confidentiality and privacy of the client and the physician. Moreover, it does not ensure that the order is correctly understood and recorded by the nurse who will enter it into the computer.

C) Writing down the order on a piece of paper before entering it into the computer is not an appropriate action as it increases the risk of transcription errors, lost or misplaced orders, or delayed entry. The nurse should enter the order directly into the computer as soon as possible and discard any paper notes after verification.

D) Confirming the order with a pharmacist before administering it to the client is not an appropriate action as it adds an unnecessary step and delays the implementation of the order. The nurse should confirm the order with the physician, not the pharmacist, and administer it to the client according to the prescribed schedule. The pharmacist will review the order for any potential interactions, allergies, or contraindications and alert the nurse if any issues arise.

A. Fever B. Headache C. Nuchal rigidity D. Photophobia

Correct Answer is C

Explanation

Nuchal rigidity

Rationale: Nuchal rigidity, or stiffness of the neck, is a classic sign of meningitis and indicates inflammation of the meninges, the membranes that cover the brain and spinal cord. Kernig's sign is a test that involves flexing the client's hip and knee at 90 degrees and then attempting to straighten the leg. A positive Kernig's sign is when the client experiences pain or resistance in the hamstring muscles, indicating meningeal irritation.

Incorrect options:

A) Fever - This is a nonspecific sign of infection and inflammation and does not indicate meningitis specifically.

B) Headache - This is a common symptom of meningitis, due to the increased intracranial pressure caused by inflammation of the meninges. However, it is not a specific sign that warrants performing a Kernig's sign test.

D) Photophobia - This is a common symptom of meningitis, due to the sensitivity of the optic nerve to light caused by inflammation of the meninges. However, it is not a specific sign that warrants performing a Kernig's sign test.

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A client who has diabetes mellitus is scheduled for a colonoscopy. The nurse instructs the client to stop taking metformin 48 hours before and after the procedure. What is the rationale for this instruction?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Explanation

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Correct Answer is C

Explanation

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A client who has diabetes mellitus is scheduled for a colonoscopy. The nurse instructs the client to stop taking metformin 48 hours before and after the procedure. What is the rationale for this instruction?

A client who has diabetes mellitus is scheduled for a colonoscopy. The nurse instructs the client to stop taking metformin 48 hours before and after the procedure.

What is the rationale for this instruction?