A nurse is completing a medication history for a client who reports using over-the-counter calcium carbonate antacid. Which of the following recommendations should the nurse make about taking this medication?

Choice A reason: CT scan with contrast is an order that the nurse should question for the client who is taking metformin for hyperglycemia. Metformin is a medication that lowers the blood glucose level by decreasing the hepatic glucose production and increasing the insulin sensitivity¹. Metformin can cause a rare but serious complication called lactic acidosis, which is a buildup of lactic acid in the blood that can cause symptoms such as weakness, nausea, vomiting, or breathing problems. CT scan with contrast involves injecting iodinated contrast material into the bloodstream, which can affect the kidney function and increase the risk of lactic acidosis in patients taking metformin. The nurse should consult with the prescriber and the pharmacist about the need to stop metformin before and after the CT scan with contrast, and to monitor the kidney function and the blood glucose level of the client.

Choice B reason: Chest X-ray 1 view is not an order that the nurse should question for the client who is taking metformin for hyperglycemia. Chest X-ray is a diagnostic test that uses a small amount of radiation to produce images of the lungs, heart, and chest wall. Chest X-ray does not involve any contrast material or affect the kidney function or the blood glucose level. The nurse should follow the standard precautions and procedures for performing a chest X-ray, such as verifying the client's identity, checking for pregnancy, removing any metal objects, and positioning the client properly.

Choice C reason: V/Q scan is not an order that the nurse should question for the client who is taking metformin for hyperglycemia. V/Q scan is a diagnostic test that measures the ventilation and perfusion of the lungs, and can detect any abnormalities such as pulmonary embolism or chronic obstructive pulmonary disease. V/Q scan involves injecting a radioactive tracer into the bloodstream and inhaling a radioactive gas, which are then detected by a special camera. V/Q scan does not affect the kidney function or the blood glucose level. The nurse should follow the standard precautions and procedures for performing a V/Q scan, such as verifying the client's identity, checking for allergies, explaining the procedure, and monitoring the vital signs.

Choice D reason: Bilateral lower extremity ultrasound is not an order that the nurse should question for the client who is taking metformin for hyperglycemia. Bilateral lower extremity ultrasound is a diagnostic test that uses sound waves to produce images of the blood vessels in the legs, and can detect any abnormalities such as deep vein thrombosis or peripheral arterial disease. Bilateral lower extremity ultrasound does not involve any contrast material or affect the kidney function or the blood glucose level. The nurse should follow the standard precautions and procedures for performing a bilateral lower extremity ultrasound, such as verifying the client's identity, explaining the procedure, and applying a gel and a probe to the legs.

Choice A reason: This is incorrect. Fluticasone is a corticosteroid that is used to treat asthma and allergic rhinitis. It does not affect the patient's ability to exercise or engage in strenuous activity. In fact, exercise can help improve lung function and reduce inflammation.

Choice B reason: This is incorrect. Fluticasone does not affect the patient's potassium levels. Potassium is an electrolyte that is important for the function of the heart, muscles, and nerves. Some medications, such as diuretics, can lower potassium levels and require the patient to eat potassium rich foods, such as bananas, potatoes, and tomatoes. Fluticasone is not one of them.

Choice C reason: This is correct. Fluticasone can cause hyperglycemia, which is high blood sugar. This can occur because corticosteroids can increase the production of glucose in the liver and reduce the sensitivity of the cells to insulin, the hormone that regulates blood sugar. Hyperglycemia can cause symptoms such as increased thirst, hunger, urination, fatigue, and blurred vision. The patient should monitor their blood sugar levels regularly and report any changes to their doctor.

Choice D reason: This is incorrect. Fluticasone does not affect the patient's digestion or appetite. It can be taken with or without food. There is no need to avoid eating for 4 hours after taking Fluticasone. However, the patient should rinse their mouth with water after using Fluticasone inhaler or nasal spray, as this can help prevent oral thrush, a fungal infection that can cause white patches, soreness, and bleeding in the mouth.