The nurse is caring for a client who is refusing to take their prescribed metformin (Glucophage). The nurse understands that the most common side effects of metformin are:
Nausea, vomiting, diarrhea
Palpitations
Headaches
Heartburn
The Correct Answer is A
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Administering the medication with meals only is not a valid adjustment for a medication that is primarily excreted by the kidneys. The food intake does not affect the renal clearance of the drug, unless it alters the pH of the urine or the blood flow to the kidneys. The nurse should follow the instructions on the medication label or the prescriber's order regarding the timing of the administration.
Choice B reason: No dose adjustment is required is an incorrect statement for a medication that is primarily excreted by the kidneys. The renal impairment can reduce the elimination of the drug and increase its concentration in the blood. This can cause adverse effects and toxicity. The nurse should consult with the prescriber or the pharmacist about the appropriate dose reduction or frequency change for the patient's level of renal function.
Choice C reason: Increasing the dose to ensure therapeutic effect is a dangerous and inappropriate adjustment for a medication that is primarily excreted by the kidneys. The renal impairment can reduce the elimination of the drug and increase its concentration in the blood. This can cause adverse effects and toxicity. The nurse should not increase the dose without the prescriber's order and should monitor the patient for signs of overdose or toxicity.
Choice D reason: Decreasing the dose to prevent toxicity is the correct and rational adjustment for a medication that is primarily excreted by the kidneys. The renal impairment can reduce the elimination of the drug and increase its concentration in the blood. This can cause adverse effects and toxicity. The nurse should consult with the prescriber or the pharmacist about the appropriate dose reduction or frequency change for the patient's level of renal function. The nurse should also monitor the patient for the therapeutic response and the adverse effects of the drug.
Correct Answer is C
Explanation
Choice A reason: This is incorrect. Taking an antacid with another antacid is redundant and unnecessary. Antacids are medicines that neutralize the acid in the stomach and relieve symptoms of heartburn, indigestion, and gastric ulcers. Taking too much antacid can cause side effects such as diarrhea, constipation, or electrolyte imbalance¹.
Choice B reason: This is incorrect. Taking an antacid as needed to reduce pain is not a good practice. Antacids are not painkillers and do not address the underlying cause of gastric ulcers. Gastric ulcers are sores in the lining of the stomach that can be caused by infection, inflammation, or erosion. Taking an antacid may temporarily relieve the pain, but it does not heal the ulcer or prevent complications. Antacids should be taken regularly as prescribed by the doctor, along with other medicines that treat the cause of the ulcer.
Choice C reason: This is correct. Taking an antacid after taking a proton pump inhibitor (PPI) is a good practice. PPIs are medicines that reduce the production of acid in the stomach and help heal gastric ulcers. However, PPIs may take several hours to work and may not provide immediate relief of symptoms. Taking an antacid after a PPI can help neutralize any remaining acid in the stomach and provide faster symptom relief. However, the antacid should be taken at least 2 hours after the PPI, as the antacid can interfere with the absorption of the PPI.
Choice D reason: This is incorrect. Reducing fluid intake with an antacid is not a good practice. Fluid intake is important for hydration, digestion, and elimination. Reducing fluid intake can cause dehydration, constipation, or kidney problems. Fluid intake does not affect the effectiveness of antacids, as long as the antacid is taken with a glass of water to help dissolve and flush it down the esophagus and into the stomach.
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