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?

Choice A reason: Vitamin C supplements are not a concern for the concurrent use with Lorazepam, which is a medication that reduces anxiety and insomnia by enhancing the effects of a neurotransmitter called gammaaminobutyric acid (GABA) in the brain¹. Vitamin C is an essential nutrient that supports the immune system and the synthesis of collagen, a protein that forms the connective tissue in the body. Vitamin C does not interact with Lorazepam or affect its metabolism or clearance.

Choice B reason: Caffeinated beverages are not a concern for the concurrent use with Lorazepam, but they may reduce its effectiveness or cause unwanted effects. Caffeine is a stimulant that increases the activity of the central nervous system and counteracts the sedative and calming effects of Lorazepam. Caffeine may also cause side effects such as nervousness, insomnia, or palpitations, especially in high doses or in sensitive individuals. The nurse should advise the patient to limit or avoid caffeine intake while taking Lorazepam, and to monitor their response to the medication.

Choice C reason: Alcohol is a concern for the concurrent use with Lorazepam, as it can increase the risk of serious and potentially fatal side effects. Alcohol is a depressant that slows down the activity of the central nervous system and enhances the effects of Lorazepam. Alcohol can cause additive effects such as excessive sedation, respiratory depression, coma, or death when taken with Lorazepam. The nurse should advise the patient to avoid alcohol consumption while taking Lorazepam, and to seek immediate medical attention if they experience any signs of overdose or toxicity.

Choice D reason: Dairy products are not a concern for the concurrent use with Lorazepam, as they do not affect its absorption, distribution, metabolism, or excretion. Dairy products are a source of calcium, protein, and other nutrients that support the bone health and the muscle function. Dairy products do not interact with Lorazepam or alter its pharmacokinetics or pharmacodynamics.

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.