A nurse is caring for a 45-year-old male client in an acute care unit.

For each provider prescription, click to specify if the intervention is anticipated or contraindicated for this client.

Metformin 500 mg PO twice daily

Bumetanide 0.5 mg/hr IV infusion

Labetalol 10 mg IV bolus x 1 dose

Oxygen at 2 L/min via simple face mask

Midodrine 10 mg PO every 8 hrs

Calcium gluconate 1 gram IV bolus x 1 dose

Potassium 20 mEq intermittent IV bolus x 1 dose

Answer and Explanation

The Correct Answer is {"A":{"answers":"B"},"B":{"answers":"B"},"C":{"answers":"A"},"D":{"answers":"A"},"E":{"answers":"B"},"F":{"answers":"B"},"G":{"answers":"A"}}

conditions. The client has dyspnea, tachycardia, and low oxygen saturation, suggesting acute illness or cardiovascular instability.
Bumetanide, a loop diuretic, is contraindicated here as it may worsen hypovolemia and electrolyte imbalance. The client’s blood pressure is high but he is already showing signs of dehydration and electrolyte abnormalities (hypokalemia). Diuretics may exacerbate hypokalemia and hypotension later.
Labetalol is anticipated for managing the acute hypertension (BP 160/98 mm Hg), especially with the client’s tachycardia and hypertensive urgency signs. It acts by blocking alpha and beta receptors to lower blood pressure safely.
Oxygen is anticipated because the client’s oxygen saturation is 92% on room air with dyspnea and tachypnea; supplemental oxygen will improve tissue oxygenation and reduce hypoxia.
Midodrine is contraindicated because it raises blood pressure via alpha-1 agonism; given the client’s elevated BP, it would worsen hypertension and increase cardiovascular risk.
Calcium gluconate is contraindicated because the client’s calcium is within normal limits (10.3 mg/dL) and giving calcium unnecessarily can cause hypercalcemia or arrhythmias.
Potassium supplementation is anticipated as the client has hypokalemia (2.8 mEq/L) on Day 2, which can cause arrhythmias and muscle weakness, requiring prompt correction.

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Correct Answer is ["200"]

Explanation

Step 1 is to determine the total volume to be infused, which is 100 mL.

Step 2 is to determine the infusion time in hours. The infusion time is 30 min, which is 0.5 hours.

Step 3 is to calculate the infusion rate in mL/hr by dividing the total volume by the infusion time in hours: 100 mL ÷ 0.5 hr = 200 mL/hr. The nurse should set the IV infusion pump to deliver 200 mL/hr.

A. A history of migraine headaches. B. Alcohol use disorder. C. A history of peptic ulcer disease. D. Tobacco use.

Correct Answer is B

Explanation

Choice A rationale

A history of migraine headaches is not a contraindication for metformin. Metformin's primary mechanism involves reducing hepatic glucose production and improving insulin sensitivity in peripheral tissues. Migraine headaches are neurological conditions not directly influenced by or interacting adversely with metformin's metabolic actions.

Choice B rationale

Alcohol use disorder is a significant contraindication for metformin due to an increased risk of lactic acidosis. Alcohol consumption can impair hepatic lactate metabolism and increase lactate production, while metformin itself can elevate lactate levels. The combination markedly raises the likelihood of this severe metabolic complication.

Choice C rationale

A history of peptic ulcer disease is not a direct contraindication for metformin. While some gastrointestinal side effects like nausea or diarrhea can occur with metformin, these are generally not severe enough to preclude its use in patients with a history of peptic ulcer disease, especially if the ulcer is currently resolved.

Choice D rationale

Tobacco use is not a direct contraindication for metformin. While tobacco use is a risk factor for various health issues, including cardiovascular disease and complications of diabetes, it does not physiologically interact with metformin in a manner that would contraindicate its use. The primary concerns with tobacco are unrelated to metformin's metabolism or side effect profile.

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A nurse is caring for a 45-year-old male client in an acute care unit. For each provider prescription, click to specify if the intervention is anticipated or contraindicated for this client.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is ["200"]

Explanation

A nurse is reviewing the medical history of a client who has a new diagnosis of diabetes mellitus and is asking about taking metformin. Which of the following client conditions should the nurse identify as a contraindication for this medication?

Correct Answer is B

Explanation

A nurse is preparing to administer verapamil 0.1 mg/kg via intermittent IV bolus over 2 min. Available is verapamil 2.5 mg/mL. The client weighs 165 Ib. How many mL should the nurse administer?

A nurse is preparing to administer medications to a client. The client tells the nurse "I will take the pills but not that liquid medication.”. Which of the following actions should the nurse take?

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A nurse is assessing a client who is taking codeine 60 mg PO every 4 hr as necessary to suppress a cough. Which of the following findings is the priority for the nurse to report to the provider?

A nurse is administering medications to a client and realizes the client received clonidine rather than the prescribed clonazepam. After checking the client's blood pressure, which of the following actions should the nurse take first?

A nurse is reviewing the medication list of a client who has a new prescription for clopidogrel after undergoing coronary artery stenting. Which of the following findings should the nurse report to the provider?

A nurse is assessing a client prior to administration of atenolol and finds that the client's apical heart rate is 61/min. Which of the following actions should the nurse take?

A nurse is caring for a 45-year-old male client in an acute care unit.

For each provider prescription, click to specify if the intervention is anticipated or contraindicated for this client.