The nurse is caring for a client who is taking metformin (Glucophage) for hyperglycemia prior to admission. The nurse would question the following order for this client:

CT scan with contrast

Chest X-ray 1 view

V/Q scan

Bilateral lower extremity ultrasound

Answer and Explanation

The Correct Answer is A

Choice A reason: CT scan with contrast is an order that the nurse should question for the client who is taking metformin for hyperglycemia. Metformin is a medication that lowers the blood glucose level by decreasing the hepatic glucose production and increasing the insulin sensitivity¹. Metformin can cause a rare but serious complication called lactic acidosis, which is a buildup of lactic acid in the blood that can cause symptoms such as weakness, nausea, vomiting, or breathing problems. CT scan with contrast involves injecting iodinated contrast material into the bloodstream, which can affect the kidney function and increase the risk of lactic acidosis in patients taking metformin. The nurse should consult with the prescriber and the pharmacist about the need to stop metformin before and after the CT scan with contrast, and to monitor the kidney function and the blood glucose level of the client.

Choice B reason: Chest X-ray 1 view is not an order that the nurse should question for the client who is taking metformin for hyperglycemia. Chest X-ray is a diagnostic test that uses a small amount of radiation to produce images of the lungs, heart, and chest wall. Chest X-ray does not involve any contrast material or affect the kidney function or the blood glucose level. The nurse should follow the standard precautions and procedures for performing a chest X-ray, such as verifying the client's identity, checking for pregnancy, removing any metal objects, and positioning the client properly.

Choice C reason: V/Q scan is not an order that the nurse should question for the client who is taking metformin for hyperglycemia. V/Q scan is a diagnostic test that measures the ventilation and perfusion of the lungs, and can detect any abnormalities such as pulmonary embolism or chronic obstructive pulmonary disease. V/Q scan involves injecting a radioactive tracer into the bloodstream and inhaling a radioactive gas, which are then detected by a special camera. V/Q scan does not affect the kidney function or the blood glucose level. The nurse should follow the standard precautions and procedures for performing a V/Q scan, such as verifying the client's identity, checking for allergies, explaining the procedure, and monitoring the vital signs.

Choice D reason: Bilateral lower extremity ultrasound is not an order that the nurse should question for the client who is taking metformin for hyperglycemia. Bilateral lower extremity ultrasound is a diagnostic test that uses sound waves to produce images of the blood vessels in the legs, and can detect any abnormalities such as deep vein thrombosis or peripheral arterial disease. Bilateral lower extremity ultrasound does not involve any contrast material or affect the kidney function or the blood glucose level. The nurse should follow the standard precautions and procedures for performing a bilateral lower extremity ultrasound, such as verifying the client's identity, explaining the procedure, and applying a gel and a probe to the legs.

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Correct Answer is C

Explanation

Choice A reason: Serum sodium level of 140 mEq/L is within the normal range of 135145 mEq/L. It does not indicate any adverse effect of the potassium sparing diuretic, which does not affect sodium excretion significantly. The nurse does not need to notify the health care provider about this finding.
Choice B reason: Blood pressure of 130/80 mmHg is slightly above the normal range of 120/80 mmHg, but it is not a cause for concern. The potassium sparing diuretic can lower the blood pressure by reducing the fluid volume and preventing sodium retention. The nurse should monitor the blood pressure regularly but does not need to notify the health care provider about this finding.
Choice C reason: Serum potassium level of 5.5 mEq/L is above the normal range of 3.55.0 mEq/L. It indicates hyperkalemia, which is a serious and potentially life-threatening complication of the potassium sparing diuretic. The potassium sparing diuretic can increase the potassium level by inhibiting its secretion in the distal tubule of the kidney. The nurse should notify the health care provider immediately and prepare to administer interventions such as calcium gluconate, insulin, or sodium bicarbonate to lower the potassium level and prevent cardiac arrhythmias.
Choice D reason: Serum potassium level of 3.5 mEq/L is at the lower end of the normal range of 3.55.0 mEq/L. It does not indicate any adverse effect of the potassium sparing diuretic, which does not cause potassium loss. The nurse does not need to notify the health care provider about this finding.

A. Antibiotics B. Pharmacologic Drug C. Prototype Drug D. Therapeutic Drug

Correct Answer is C

Explanation

Choice A reason: This is incorrect. Antibiotics are not a term for a drug model, but a class of drugs that are used to treat bacterial infections. Antibiotics can have different chemical structures, mechanisms of action, and modes of action. For example, penicillin is a prototype drug of the beta lactam antibiotics, which inhibit the synthesis of bacterial cell walls¹.

Choice B reason: This is incorrect. Pharmacologic drug is not a term for a drug model, but a general term for any substance that has a physiological effect on the body. Pharmacologic drugs can belong to different classes, such as analgesics, antihistamines, or antivirals. For example, aspirin is a prototype drug of the nonsteroidal anti-inflammatory drugs (NSAIDs), which reduce pain, inflammation, and fever.

Choice C reason: This is correct. Prototype drug is the term used for a well understood drug model with which other drugs in its representative class are compared. A prototype drug is an individual drug that has similar chemical structure, mechanism of action, and mode of action as other drugs in its class. A prototype drug is often the first developed or the most important drug in its class, and is used as a reference for comparison. For example, morphine is a prototype drug of the opioid analgesics, which relieve pain by binding to opioid receptors in the brain and spinal cord.

Choice D reason: This is incorrect. Therapeutic drug is not a term for a drug model, but a term for any drug that is used to treat or prevent a disease or disorder. Therapeutic drugs can belong to different classes, such as antibiotics, antihypertensives, or antidepressants. For example, metformin is a prototype drug of the biguanide antidiabetic drugs, which lower blood glucose levels by reducing glucose production in the liver and increasing glucose uptake in the muscles.

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The nurse is caring for a client who is taking metformin (Glucophage) for hyperglycemia prior to admission. The nurse would question the following order for this client:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is monitoring a client taking a potassium sparing diuretic. Which of the following findings would prompt the nurse to notify the health care provider?

Correct Answer is C

Explanation

What is the term used for a well understood drug model with which other drugs in its representative class are compared?

Correct Answer is C

Explanation

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