A nurse is reviewing the medication list of a client who has diabetes mellitus and is scheduled for surgery. The client takes metformin orally twice a day. Which of the following actions should the nurse take?

Instruct the client to take their morning dose of metformin with a sip of water on the day of surgery.

Instruct the client to hold their metformin for 48 hours before and after surgery.

Instruct the client to resume their metformin as soon as they can tolerate oral intake after surgery.

Instruct the client to switch to insulin injections until they recover from surgery.

Answer and Explanation

The Correct Answer is B

B) Correct. The nurse should instruct the client to hold their metformin for 48 hours before and after surgery as this drug can increase the risk of lactic acidosis in clients who are undergoing procedures that involve contrast media or who have impaired renal function due to dehydration or hypotension.

A) Incorrect. The nurse should not instruct the client to take their morning dose of metformin with a sip of water on the day of surgery as this can cause hypoglycemia during anesthesia or interfere with contrast media if used during surgery.

C) Incorrect. The nurse should not instruct the client to resume their metformin as soon as they can tolerate oral intake after surgery as this can cause lactic acidosis if the client's renal function is not fully restored or if they receive contrast media during surgery or postoperatively.

D) Incorrect. The nurse should not instruct the client to switch to insulin injections until they recover from surgery as this can cause hyperglycemia or hypoglycemia depending on the type and dose of insulin used and the client's nutritional status and blood glucose levels.

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Correct Answer is A

Explanation

A) Incorrect. The client should not avoid eating foods that are high in vitamin K, such as leafy greens, broccoli, and soybeans. These foods can interfere with the anticoagulant effect of warfarin and increase the risk of clotting. The client should eat a consistent amount of vitamin K-rich foods and avoid sudden changes in their intake.

B) Correct. The client should use a soft-bristled toothbrush to prevent bleeding from the gums. Warfarin can impair the blood's ability to clot and increase the risk of bleeding from minor injuries.

C) Correct. The client should monitor their blood pressure regularly at home and report any abnormal readings to their provider. Warfarin can affect blood pressure and increase the risk of stroke or bleeding.

D) Correct. The client should report any signs of bruising or bleeding to their provider, such as nosebleeds, blood in urine or stool, heavy menstrual bleeding, or prolonged bleeding from cuts. These signs may indicate that the warfarin dose is too high and needs adjustment.

A. The nurse injects air into the NPH vial first, then into the regular vial. B. The nurse draws up regular insulin first, then NPH insulin. C. The nurse rolls the NPH vial between their palms before drawing up insulin. D. The nurse wipes the rubber stoppers of both vials with alcohol swabs.

Correct Answer is B

Explanation

A) Incorrect. The nurse should inject air into the regular vial first, then into the NPH vial. This can prevent contamination of the regular insulin with NPH insulin and ensure accurate dosing.

B) Correct. The nurse should draw up regular insulin first, then NPH insulin. This can prevent contamination of the regular insulin with NPH insulin and ensure accurate dosing. Regular insulin is clear and NPH insulin is cloudy.

C) Correct. The nurse should roll the NPH vial between their palms before drawing up insulin. This can resuspend the insulin particles that may have settled at the bottom of the vial and ensure uniform concentration.

D) Correct. The nurse should wipe the rubber stoppers of both vials with alcohol swabs before inserting needles. This can reduce the risk of infection and contamination.

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A nurse is reviewing the medication list of a client who has diabetes mellitus and is scheduled for surgery. The client takes metformin orally twice a day. Which of the following actions should the nurse take?

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Naxlex Comprehensive Predictor Exams

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