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.

Answer and Explanation

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.

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Correct Answer is C

Explanation

Choice A rationale

Constipation is a very common and expected adverse effect of codeine due to its opioid effects on gastrointestinal motility, specifically by decreasing propulsive contractions. While it requires management, it is generally not the highest priority unless it leads to severe complications like impaction, making other acute symptoms more immediately concerning. Normal bowel frequency varies but ranges from three times daily to three times weekly.

Choice B rationale

Dry mouth, or xerostomia, is a common anticholinergic-like effect of opioid medications like codeine. While uncomfortable, it is typically a mild, non-life-threatening side effect. It can be managed with hydration and oral hygiene measures and does not represent an acute physiological threat requiring immediate reporting as a priority.

Choice C rationale

Agitation, especially in the context of opioid use, can be a sign of central nervous system excitation or an idiosyncratic reaction. It can indicate a paradoxical effect of the medication or an emerging adverse event that could escalate to more serious neurological complications, such as seizures or respiratory compromise if not promptly addressed.

Choice D rationale

Urinary retention is a known adverse effect of opioids due to their effect on bladder detrusor muscle tone and sphincter function. While it is important to monitor and manage, potentially requiring catheterization, it is generally not as immediately life-threatening as signs of central nervous system instability or respiratory compromise, making agitation a higher priority in the acute setting.

Correct Answer is ["3"]

Explanation

Step 1 is: Convert client weight from pounds to kilograms. 165 Ib ÷ 2.2 Ib/kg = 75 kg.

Step 2 is: Calculate the total dose of verapamil needed. 0.1 mg/kg × 75 kg = 7.5 mg.

Step 3 is: Calculate the volume to administer in mL. 7.5 mg ÷ (2.5 mg/mL) = 3 mL. The nurse should administer 3 mL.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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?

Correct Answer is C

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?

Correct Answer is ["3"]

Explanation

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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?