A patient with a suspected myocardial infarction is in the emergency department. The nurse is preparing to administer 325 mg of aspirin.
What action should the nurse take?

Choice A rationale:

Respiratory distress is not a direct side effect of metformin. While metformin can cause a rare condition called lactic acidosis, which can lead to rapid breathing, respiratory distress is not a primary concern with metformin use.

Respiratory distress typically involves difficulty breathing due to other causes such as asthma, pneumonia, heart failure, or chronic obstructive pulmonary disease (COPD).

Choice B rationale:

Seizures are not a known side effect of metformin.

Seizures are typically associated with neurological conditions, such as epilepsy, or metabolic disturbances such as hypoglycemia or electrolyte imbalances.

Metformin does not directly affect the central nervous system in a way that would increase the risk of seizures.

Choice C rationale:

Lactic acidosis:

This is a rare but serious condition that can occur with metformin use.

It happens when lactic acid builds up in the bloodstream, causing the blood to become too acidic. Symptoms of lactic acidosis include:

Rapid breathing Nausea and vomiting Abdominal pain Muscle weakness Unusual sleepiness Feeling cold

Risk factors for lactic acidosis in patients taking metformin include:

Kidney disease Congestive heart failure Liver disease Dehydration

Excessive alcohol intake Recent surgery or heart attack

It's important to note that lactic acidosis is rare, occurring in about 3 to 10 cases per 100,000 people taking metformin per year.

Renal failure:

Metformin is primarily eliminated by the kidneys.

If kidney function is impaired, metformin can build up in the body, increasing the risk of lactic acidosis. Additionally, metformin can potentially cause kidney damage in rare cases, further worsening kidney function. It's crucial to monitor kidney function regularly in patients taking metformin.

Choice D rationale:

Hyperglycemia (high blood sugar) is not a side effect of metformin.

In fact, metformin is a medication used to lower blood sugar levels in people with type 2 diabetes. It works by:

Decreasing the amount of glucose produced by the liver Improving the body's sensitivity to insulin

Slowing the absorption of glucose from the intestines

Choice A rationale:

Increasing the amiodarone infusion rate would worsen the patient's bradycardia and hypotension. Amiodarone is a class III antiarrhythmic drug that works by prolonging the action potential duration in cardiac cells. This can lead to a decrease in heart rate and contractility.

Increasing the dose in this patient could lead to further hemodynamic compromise.

Choice B rationale:

Decreasing the amiodarone infusion rate is the most appropriate action in this situation. This will help to mitigate the drug's effects on the patient's heart rate and blood pressure.

A dose reduction may allow the heart rate to recover to a safer level while still maintaining the antiarrhythmic benefits of amiodarone.

Choice C rationale:

Continuing the amiodarone infusion at the current rate is not appropriate, as it is likely to worsen the patient's bradycardia and hypotension.

Maintaining the current dose could lead to further clinical deterioration.

Choice D rationale:

Discontinuing the amiodarone infusion entirely may not be necessary at this point. The patient's arrhythmia may still require treatment with amiodarone.

A dose reduction may be sufficient to address the patient's hemodynamic instability while still providing therapeutic benefits.