A patient with frequent tension headaches asks the nurse about over-the-counter remedies. The nurse knows that Excedrin combines which of the following active ingredients to address pain, inflammation, and increased vascular tone associated with headaches?

Choice A reason: This is correct. Nausea, vomiting, and diarrhea are the most common side effects of metformin, especially when the drug is started or the dose is increased. These side effects occur because metformin can interfere with the absorption of glucose and other nutrients in the intestines, causing osmotic diarrhea. The nurse should advise the client to take metformin with food, start with a low dose and gradually increase it, and drink plenty of fluids to prevent dehydration. The nurse should also monitor the client for signs of lactic acidosis, a rare but serious complication of metformin that causes severe diarrhea, abdominal pain, muscle cramps, and difficulty breathing.

Choice B reason: This is incorrect. Palpitations are not a common side effect of metformin. Palpitations are the sensation of a rapid, irregular, or pounding heartbeat, which can be caused by various factors, such as stress, anxiety, caffeine, nicotine, or heart problems. Metformin does not affect the heart rate or rhythm directly, but it can lower the blood sugar levels, which can trigger the release of adrenaline, a hormone that can cause palpitations. The nurse should check the client's blood sugar levels and advise the client to eat regular meals and snacks, avoid alcohol and caffeine, and report any chest pain or shortness of breath.

Choice C reason: This is incorrect. Headaches are not a common side effect of metformin. Headaches are the pain or discomfort in the head, scalp, or neck, which can be caused by various factors, such as stress, dehydration, or sinus infection. Metformin does not cause headaches directly, but it can lower the blood sugar levels, which can cause headaches as a symptom of hypoglycemia. The nurse should check the client's blood sugar levels and advise the client to eat regular meals and snacks, drink plenty of water, and take painkillers as needed.

Choice D reason: This is incorrect. Heartburn is not a common side effect of metformin. Heartburn is the burning sensation in the chest or throat, which is caused by the reflux of stomach acid into the esophagus. Metformin does not cause heartburn directly, but it can worsen it if the client already has gastroesophageal reflux disease (GERD), a condition where the lower esophageal sphincter is weak or relaxed and allows the acid to flow back. The nurse should advise the client to take metformin with food, avoid spicy or fatty foods, elevate the head of the bed, and take antacids as needed.

Choice A reason: Increased respiratory rate is not a sign of adverse reaction to metoprolol, but rather a normal response to hypoxia or distress. Metoprolol is a betablocker that can lower the heart rate and blood pressure, but it does not affect the respiratory rate directly.

Choice B reason: Bronchodilation is not a sign of adverse reaction to metoprolol, but rather a desired effect of asthma medications such as betaagonists or anticholinergics. Metoprolol is a betablocker that can block the beta receptors in the lungs, which can cause bronchoconstriction or narrowing of the airways. This is why metoprolol is contraindicated or used with caution in clients with asthma.

Choice C reason: Decreased sputum production is not a sign of adverse reaction to metoprolol, but rather a result of effective asthma management. Metoprolol is a betablocker that does not have any direct effect on the mucus secretion or inflammation in the lungs.

Choice D reason: Wheezing is a sign of adverse reaction to metoprolol, as it indicates bronchoconstriction or narrowing of the airways. Metoprolol is a betablocker that can block the beta receptors in the lungs, which can reduce the bronchodilation effect of beta agonists or other asthma medications. This can worsen the asthma symptoms and cause wheezing, coughing, dyspnea, or chest tightness. The nurse should monitor the client for these signs and report them to the prescriber immediately.