A nurse is caring for a 3-year-old child immediately following a tonic-clonic seizure. Which of the following actions should the nurse take?

Calculation:

• Identify the ordered dose and available concentration

Ordered Dose: 0.25 mg
Available Concentration: 1 mg/mL

• Calculate the volume to administer

Volume (mL) = Ordered Dose ÷ Concentration

Volume = 0.25 ÷ 1

= 0.25 mL

The client reports dizziness, lightheadedness, and problems when skipping meals, which suggests concern for blood glucose instability and cardiovascular effects of prescribed medications. Beta-blockers such as metoprolol can mask the adrenergic warning signs of hypoglycemia, making low blood sugar more dangerous for diabetic clients. Recognizing medication interactions and adverse effects is essential for preventing complications and promoting safe chronic disease management.

Rationale for correct choices:

• Hypoglycemia: Clients with diabetes are at risk for hypoglycemia, especially when meals are skipped or appetite is poor. Even though metformin itself rarely causes hypoglycemia, missed meals combined with glucose-lowering therapy can increase risk. In addition, beta-blockers can prevent recognition of early warning signs such as tachycardia and tremors. This makes hypoglycemia the most significant potential complication requiring attention.

• Metoprolol: This is a beta-blocker that can mask common adrenergic symptoms of hypoglycemia such as palpitations, tremors, and tachycardia. As a result, the client may not recognize blood glucose drops until symptoms become severe, such as confusion or syncope. Since this client already reports skipping meals, the risk becomes more significant.

Rationale for incorrect choices:

• Bradycardia: Although metoprolol can cause bradycardia, the client’s current heart rate is 62/min, which is within normal range and not immediately concerning. The greater risk is unrecognized hypoglycemia because the client reports skipped meals and dizziness. Bradycardia is possible, but it is less urgent and less supported by the findings than hypoglycemia.

• Paresthesia: This is more commonly associated with diabetic neuropathy or significant electrolyte disturbances rather than the medications listed here. The potassium level is normal at 3.5 mEq/L, and potassium chloride is being given to maintain balance, not causing neurologic symptoms. Metformin may contribute to vitamin B12 deficiency over long-term use, but that is not the primary risk highlighted in this scenario.

• Metformin: This primarily lowers hepatic glucose production and generally does not cause hypoglycemia when used alone. It is safer in this regard compared to insulin or sulfonylureas. While skipped meals may still contribute to low glucose symptoms, metformin itself is not the major cause of masked or severe hypoglycemia.

• Potassium: Potassium chloride is prescribed to prevent or correct hypokalemia and does not directly cause hypoglycemia. The client’s potassium level is at the lower end of normal, making supplementation appropriate. While abnormal potassium levels can affect cardiac conduction and muscle function, they do not explain the client’s concern about skipped meals and blood sugar changes.