A patient is prescribed metformin (Glucophage). Which side effect/adverse effect almost always occurs when clients take metformin (Glucophage)?
Fever.
Insomnia.
Bitter or metallic taste.
Seizures.
The Correct Answer is C
Choice A rationale:
Fever is not a common side effect of metformin. While it's possible for a minority of patients to experience a mild fever as their bodies adjust to the medication, it's not considered a typical or expected adverse effect.
Fevers typically occur due to infections or inflammation, and metformin does not directly cause either of these processes.
If a patient taking metformin develops a fever, it's crucial to rule out other potential causes, such as infections or other medications, before attributing it to metformin.
Choice B rationale:
Insomnia is also not a common side effect of metformin. In fact, some studies have suggested that metformin may even have a positive effect on sleep quality in some individuals.
While sleep disturbances can occur with any medication, they are not specifically associated with metformin.
If a patient experiences insomnia while taking metformin, it's essential to consider other potential factors, such as stress, anxiety, or other medications, that could be contributing to sleep problems.
Choice C rationale:
Bitter or metallic taste is a very common side effect of metformin, experienced by approximately 30-40% of patients. This taste disturbance is thought to be caused by metformin's interaction with taste receptors on the tongue.
The taste is often described as metallic, bitter, or similar to the taste of pennies.
While it can be unpleasant, it's generally not considered a serious side effect and does not usually require discontinuation of the medication.
Some strategies to manage the metallic taste include: Taking metformin with meals or snacks to mask the taste.
Chewing sugar-free gum or sucking on hard candy after taking the medication. Rinsing the mouth with water or mouthwash after taking the medication.
Switching to an extended-release formulation of metformin, which may have a less pronounced metallic taste.
Choice D rationale:
Seizures are a rare but serious side effect of metformin.
They are most likely to occur in patients with underlying kidney problems or those taking certain other medications that can interact with metformin.
If a patient taking metformin experiences a seizure, it's critical to seek immediate medical attention.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Dopamine is a catecholamine that acts on both alpha- and beta-adrenergic receptors. It has inotropic (increases heart contractility), chronotropic (increases heart rate), and vasopressor (constricts blood vessels) effects.
It was previously used as a first-line agent for cardiogenic shock, but it has fallen out of favor due to concerns about its potential to increase heart rate and arrhythmias, which can worsen myocardial oxygen demand and ischemia.
Additionally, dopamine's effects on renal blood flow can be unpredictable, and it may not be as effective as norepinephrine in increasing blood pressure in patients with severe shock.
Choice B rationale:
Norepinephrine is a potent alpha-adrenergic agonist that causes vasoconstriction, leading to an increase in blood pressure. It has minimal beta-adrenergic effects, so it does not significantly increase heart rate.
Norepinephrine is the preferred first-line vasopressor for cardiogenic shock because it effectively raises blood pressure without significantly increasing heart rate or myocardial oxygen demand.
It also has beneficial effects on renal blood flow and may improve organ perfusion.
Choice C rationale:
Epinephrine is a potent alpha- and beta-adrenergic agonist. It has strong inotropic, chronotropic, and vasopressor effects.
It can be used in cardiogenic shock, but it is typically reserved for patients who do not respond adequately to norepinephrine or who have severe bradycardia.
Epinephrine's potent beta-adrenergic effects can increase heart rate and myocardial oxygen demand, which can be detrimental in patients with cardiogenic shock.
Choice D rationale:
Vasopressin (Pitressin) is a hormone that acts on V1 receptors in vascular smooth muscle to cause vasoconstriction. It is not a first-line agent for cardiogenic shock, but it can be used as an adjunct to norepinephrine in patients who are refractory to other vasopressors.
Vasopressin may be particularly useful in patients with septic shock, as it has been shown to improve outcomes in this population.
Correct Answer is A
Explanation
Choice A rationale:
Requesting that the patient eat lunch first if testing is further delayed is the most appropriate action to prevent hypoglycemia for the following reasons:
1. Timing of NPH Insulin Peak:
NPH insulin is an intermediate-acting insulin with a peak action time of 4-12 hours after administration.
In this case, the patient received NPH insulin at 7:00 AM, meaning its peak effect is likely to occur between 11:00 AM and 5:00 PM.
Delaying lunch beyond 1:00 PM significantly increases the risk of hypoglycemia as the insulin's action peaks without adequate food intake to balance glucose levels.
2. Ensuring Consistent Mealtimes:
Consistency in meal timing is crucial for managing blood glucose levels in diabetic patients. Delaying meals can disrupt the balance between insulin and glucose, leading to hypoglycemia.
Prioritizing lunch at the usual time, even amidst testing delays, helps maintain a more predictable glucose pattern.
3. Addressing Acute Hypoglycemia Risk:
Hypoglycemia is a serious complication of diabetes that can occur if blood glucose levels fall too low. Symptoms can include shakiness, sweating, dizziness, confusion, and even loss of consciousness.
Promptly addressing potential delays in food intake is essential to prevent hypoglycemia and its associated risks.
Rationales for other choices:
Choice B: Discontinuing the evening dose of insulin does not address the immediate risk of hypoglycemia due to the missed lunch. It could lead to hyperglycemia later in the day or overnight.
Choice C: Saving the lunch tray for later may not be feasible if testing is significantly delayed. It also does not prevent hypoglycemia in the immediate timeframe.
Choice D: While a glass of orange juice can provide a quick source of glucose, it is a short-term solution and does not replace a balanced meal. It could also lead to a rapid rise in blood glucose followed by a subsequent drop.
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