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 C
Explanation
Choice A rationale
Sodium bicarbonate is used to treat metabolic acidosis or certain drug overdoses, but it does not directly address hypocalcemia, which is the underlying cause of a positive Trousseau's sign. Its primary action is to increase systemic pH, not calcium levels.
Choice B rationale
Magnesium sulfate is administered for magnesium deficiencies, pre-eclampsia, or certain arrhythmias. While magnesium deficiency can sometimes exacerbate hypocalcemia, it is not the primary treatment for Trousseau's sign, which specifically indicates low calcium.
Choice C rationale
Calcium gluconate is the appropriate medication to administer for a positive Trousseau's sign, as this sign indicates hypocalcemia (low serum calcium levels). Calcium gluconate directly replenishes calcium, correcting the neuromuscular excitability caused by insufficient extracellular calcium.
Choice D rationale
Potassium chloride is given to treat hypokalemia (low potassium levels). While electrolyte imbalances can be complex, a positive Trousseau's sign is specifically indicative of hypocalcemia, not hypokalemia, and potassium administration would not resolve the underlying issue.
Correct Answer is A
Explanation
Choice A rationale
Alendronate is a bisphosphonate medication used to treat osteoporosis. It is known to be highly irritating to the esophageal mucosa, and if it lodges in the esophagus, it can cause severe esophagitis, ulceration, or erosion. Assessing the client's ability to swallow ensures safe passage of the medication and minimizes the risk of esophageal injury, highlighting a critical safety measure.
Choice B rationale
Alendronate should not be administered before bed. For optimal absorption and to minimize the risk of esophageal irritation, alendronate must be taken in the morning upon waking, at least 30 minutes before the first food, beverage, or medication. Taking it before bed increases the likelihood of the pill lingering in the esophagus, leading to irritation and potential injury.
Choice C rationale
Alendronate should not be administered with orange juice. The absorption of alendronate is significantly impaired by food, beverages other than plain water, and certain minerals like calcium. Orange juice contains calcium and can decrease the bioavailability of the medication, thereby reducing its therapeutic effectiveness. It must be taken with plain water only.
Choice D rationale
Informing the client to remain supine after taking the medication is incorrect. To facilitate rapid transit to the stomach and minimize esophageal contact, clients must remain upright (sitting or standing) for at least 30 minutes after taking alendronate, and until after their first food of the day. Lying down increases the risk of esophageal reflux and irritation.
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