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?
A history of migraine headaches.
Alcohol use disorder.
A history of peptic ulcer disease.
Tobacco use.
The Correct Answer is B
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","D"]
Explanation
Choice A rationale: Orthostatic hypotension is a common side effect of carbidopa-levodopa due to its vasodilatory effects and impact on the autonomic nervous system. Patients may experience dizziness or lightheadedness when standing up quickly, caused by a drop in blood pressure. Normal blood pressure ranges around 120/80 mm Hg, and sudden decreases can lead to falls, especially in Parkinson’s disease patients who already have balance issues.
Choice B rationale: Wearing-off phenomenon is common with carbidopa-levodopa therapy. This occurs when medication effects diminish before the next dose, causing symptom recurrence such as bradykinesia and tremor. The medication has a relatively short half-life, and patients often report fluctuation in symptom control, especially as disease progresses. Understanding this helps manage expectations and medication timing.
Choice C rationale: High-protein diets can interfere with the absorption of levodopa, as dietary amino acids compete with levodopa for transport across the intestinal mucosa and the blood-brain barrier. Patients are typically advised to moderate protein intake during dosing times to maximize medication effectiveness, rather than increase protein consumption.
Choice D rationale: Levodopa is best absorbed on an empty stomach because food, particularly proteins, delays gastric emptying and competes with levodopa for absorption. Taking the medication 30 minutes before or 1 hour after meals improves bioavailability and symptom control. This knowledge helps optimize medication efficacy.
Choice E rationale: Parkinson’s symptoms usually do not resolve within days of starting carbidopa-levodopa. It often takes weeks to months for optimal symptom control and dose adjustments. Patients should understand that this medication manages symptoms but is not a cure and requires ongoing therapy.
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.
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