What is the fastest route for medication administration?

Choice A reason: Vasodilation is not the primary therapeutic effect of atropine in this scenario. Atropine is a medication that blocks the action of acetylcholine, a neurotransmitter that stimulates the parasympathetic nervous system. Atropine can cause vasodilation by inhibiting the muscarinic receptors on the blood vessels, which normally cause vasoconstriction. However, this effect is not significant or consistent, and it does not improve the symptoms of bradycardia, which is a slow heart rate that can cause dizziness, fatigue, or fainting. The nurse should monitor the blood pressure and the peripheral pulses of the patient after administering atropine.

Choice B reason: Bronchodilation is not the primary therapeutic effect of atropine in this scenario. Atropine is a medication that blocks the action of acetylcholine, a neurotransmitter that stimulates the parasympathetic nervous system. Atropine can cause bronchodilation by inhibiting the muscarinic receptors on the bronchial smooth muscle, which normally cause bronchoconstriction. However, this effect is not relevant or beneficial for the patient with symptomatic bradycardia, who does not have any respiratory problems. The nurse should assess the respiratory rate and the breath sounds of the patient after administering atropine.

Choice C reason: Increase in heart rate is the primary therapeutic effect of atropine in this scenario. Atropine is a medication that blocks the action of acetylcholine, a neurotransmitter that stimulates the parasympathetic nervous system. Atropine can increase the heart rate by inhibiting the muscarinic receptors on the sinoatrial node and the atrioventricular node, which normally slow down the heart rate. This effect is desirable and beneficial for the patient with symptomatic bradycardia, who has a slow heart rate that can cause dizziness, fatigue, or fainting. The nurse should monitor the electrocardiogram and the heart rate of the patient after administering atropine.

Choice D reason: Diuresis is not the primary therapeutic effect of atropine in this scenario. Atropine is a medication that blocks the action of acetylcholine, a neurotransmitter that stimulates the parasympathetic nervous system. Atropine can cause diuresis by inhibiting the muscarinic receptors on the bladder, which normally promote urination. However, this effect is not important or helpful for the patient with symptomatic bradycardia, who does not have any urinary problems. The nurse should measure the urine output and the specific gravity of the patient after administering atropine.

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.