A nurse is assessing an infant who has hydrocephalus.
Which of the following clinical manifestations should the nurse expect?

Choice A rationale

Metformin, a biguanide, commonly causes gastrointestinal side effects, but diarrhea, not constipation, is a more frequent occurrence during the initial phase of therapy. This effect is dose-dependent and results from increased intestinal motility and changes in the gut microbiome. Starting with a low dose and titrating slowly helps mitigate these symptoms.

Choice B rationale

Taking metformin at the same time each day helps maintain a steady therapeutic concentration in the bloodstream. This consistency is crucial for effective glycemic control, as the medication works by decreasing hepatic glucose production and increasing insulin sensitivity. Adherence to a consistent schedule reduces the risk of missed doses and helps prevent fluctuations in blood glucose levels.

Choice C rationale

Metformin is used as a long-term therapy for managing type 2 diabetes, not for short-term symptom relief. Type 2 diabetes is a chronic condition that requires continuous management to prevent complications. Metformin's effectiveness depends on its consistent presence in the body to regulate glucose metabolism and improve insulin utilization over an extended period.

Choice D rationale

Metformin is typically taken with meals to minimize gastrointestinal side effects, such as diarrhea and nausea, not before them. Taking the medication with food, especially the evening meal, can improve tolerability. Its absorption is not significantly affected by food, making this a safe and effective strategy for managing patient comfort.

Choice A rationale

Performing passive range of motion exercises on an acutely affected joint with hemarthrosis can exacerbate bleeding and cause further damage to the joint capsule and surrounding tissues. The goal is to minimize movement to allow the bleeding to stop and the joint to heal, preventing long-term joint destruction and chronic arthropathy. Gentle, active range of motion may be initiated later, after the acute phase.

Choice B rationale

Applying heat to a joint experiencing an acute bleed, or hemarthrosis, is contraindicated because vasodilation will occur. The increased blood flow to the area would intensify the bleeding into the joint space, increasing swelling, pain, and the risk of permanent joint damage. Cold therapy, or cryotherapy, is the appropriate intervention to promote vasoconstriction and reduce bleeding.

Choice C rationale

Elevating the affected limb above the level of the heart uses gravity to reduce blood flow to the injured joint. This action decreases the pressure within the blood vessels, which helps to slow or stop the bleeding into the joint space (hemarthrosis), thereby reducing swelling, pain, and potential long-term damage to the cartilage and bone.

Choice D rationale

Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) with antiplatelet properties. It irreversibly inhibits cyclooxygenase (COX) enzymes, preventing the production of thromboxane A2, which is essential for platelet aggregation. In a child with hemophilia, administering aspirin would inhibit the little clotting ability they have, increasing the risk of prolonged and severe bleeding.