Which client statement demonstrates understanding of the nurse’s teaching for levothyroxine (Synthroid)?

Choice A rationale:

Respiratory distress is not a direct side effect of metformin. While metformin can cause a rare condition called lactic acidosis, which can lead to rapid breathing, respiratory distress is not a primary concern with metformin use.

Respiratory distress typically involves difficulty breathing due to other causes such as asthma, pneumonia, heart failure, or chronic obstructive pulmonary disease (COPD).

Choice B rationale:

Seizures are not a known side effect of metformin.

Seizures are typically associated with neurological conditions, such as epilepsy, or metabolic disturbances such as hypoglycemia or electrolyte imbalances.

Metformin does not directly affect the central nervous system in a way that would increase the risk of seizures.

Choice C rationale:

Lactic acidosis:

This is a rare but serious condition that can occur with metformin use.

It happens when lactic acid builds up in the bloodstream, causing the blood to become too acidic. Symptoms of lactic acidosis include:

Rapid breathing Nausea and vomiting Abdominal pain Muscle weakness Unusual sleepiness Feeling cold

Risk factors for lactic acidosis in patients taking metformin include:

Kidney disease Congestive heart failure Liver disease Dehydration

Excessive alcohol intake Recent surgery or heart attack

It's important to note that lactic acidosis is rare, occurring in about 3 to 10 cases per 100,000 people taking metformin per year.

Renal failure:

Metformin is primarily eliminated by the kidneys.

If kidney function is impaired, metformin can build up in the body, increasing the risk of lactic acidosis. Additionally, metformin can potentially cause kidney damage in rare cases, further worsening kidney function. It's crucial to monitor kidney function regularly in patients taking metformin.

Choice D rationale:

Hyperglycemia (high blood sugar) is not a side effect of metformin.

In fact, metformin is a medication used to lower blood sugar levels in people with type 2 diabetes. It works by:

Decreasing the amount of glucose produced by the liver Improving the body's sensitivity to insulin

Slowing the absorption of glucose from the intestines

Rationale for A:

Regular insulin is the only insulin formulation that can be safely administered intravenously. It is a rapid-acting insulin that starts working within 15 minutes and peaks in 1-2 hours, making it ideal for urgent glucose control in situations like diabetic ketoacidosis.

NPH insulin is an intermediate-acting insulin that is not suitable for IV administration. It is designed to be absorbed slowly over several hours, and injecting it intravenously could lead to unpredictable and potentially dangerous fluctuations in blood glucose levels.

Subcutaneous (SQ) injection is the standard route of administration for both regular and NPH insulin outside of acute care settings. This route allows for a more gradual and consistent absorption of insulin, which is essential for maintaining stable blood glucose control.

The patient's transfer to the med/surg unit indicates that their condition has stabilized and no longer requires the aggressive glucose control that is achieved with an IV insulin infusion. Therefore, it is appropriate to transition them to SQ insulin injections.

Rationale for B:

While mixing insulins can potentially alter their absorption rates and action profiles, the primary concern with mixing NPH and regular insulin is not an increased risk of hypoglycemia. It is the incompatibility of the formulations for IV administration.

Rationale for C:

NPH and regular insulin can be mixed together for subcutaneous injection, but they are not compatible for intravenous administration.

Rationale for D:

While NPH insulin can be administered as part of an IV insulin drip in the ICU, this is typically done in specific situations where a continuous infusion of both rapid-acting and intermediate-acting insulin is required. It is not the standard practice for NPH insulin administration.