A client with type 2 diabetes mellitus is prescribed metformin, a biguanide antidiabetic agent. The nurse should instruct the client to monitor for which adverse effect of this medication?

Lactic acidosis is a rare but potentially fatal complication of metformin therapy, especially in clients with renal impairment, liver disease, heart failure, or alcohol abuse. It occurs when metformin accumulates in the body and causes an increase in lactate production and a decrease in lactate clearance, leading to metabolic acidosis. Symptoms of lactic acidosis include nausea, vomiting, abdominal pain, hyperventilation, muscle weakness, and confusion.

Incorrect options:

A) Hypoglycemia - This is an incorrect option, as metformin does not cause hypoglycemia by itself. However, hypoglycemia may occur if metformin is combined with other antidiabetic agents that lower blood glucose levels, such as sulfonylureas or insulin.

C) Pancreatitis - This is an incorrect option, as metformin does not cause pancreatitis. However, pancreatitis may occur as a complication of diabetes mellitus or as an adverse effect of other antidiabetic agents, such as glucagon-like peptide-1 (GLP-1) agonists or dipeptidyl peptidase-4 (DPP-4) inhibitors.

D) Hepatotoxicity - This is an incorrect option, as metformin does not cause hepatotoxicity. However, hepatotoxicity may occur as a complication of diabetes mellitus or as an adverse effect of other antidiabetic agents, such as thiazolidinediones or alpha-glucosidase inhibitors.

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that is commonly used to treat pain and inflammation in clients with RA. However, NSAIDs can also inhibit platelet aggregation and prolong bleeding time, increasing the risk of hemorrhage during and after surgery. Therefore, ibuprofen should be discontinued at least 7 days before the surgery.

Incorrect options:

A) Prednisone - This is an incorrect option, as prednisone is a corticosteroid that is used to suppress inflammation and immune responses in clients with RA. Prednisone does not affect bleeding time or platelet function. However, prednisone can increase the risk of infection and delay wound healing, so it should be tapered gradually before the surgery to avoid adrenal insufficiency and withdrawal symptoms.

B) Methotrexate - This is an incorrect option, as methotrexate is a disease-modifying antirheumatic drug (DMARD) that is used to slow down the progression of joint damage and reduce inflammation in clients with RA. Methotrexate does not affect bleeding time or platelet function. However, methotrexate can increase the risk of infection and bone marrow suppression, so it should be discontinued at least 2 weeks before the surgery.

D) Hydroxychloroquine - This is an incorrect option, as hydroxychloroquine is an antimalarial drug that is used to treat mild to moderate RA. Hydroxychloroquine does not affect bleeding time or platelet function. However, hydroxychloroquine can cause ocular toxicity, so it should be monitored regularly by an ophthalmologist.