A client with a history of angina reports the onset of chest pain. The nurse determines that the heart rate is 104 beats/minute and the blood pressure is 138/86 mm Hg. A transdermal nitroglycerin patch was applied 30 minutes ago to the right upper chest. Which action should the nurse take?

A) CT scan that was performed six months earlier: A previous CT scan performed six months earlier does not necessarily require follow-up by the nurse. However, it would be important to review the results of the previous CT scan to compare findings and assess for any changes over time.

B) Takes metformin hydrochloride for type 2 diabetes mellitus: This is the correct answer. Metformin is excreted by the kidneys, and contrast media used in CT scans can potentially cause kidney damage, particularly in clients with pre-existing renal impairment. Therefore, clients taking metformin may be at increased risk of developing lactic acidosis if renal function is compromised. It is essential for the nurse to follow up on this information and coordinate with the healthcare provider to determine whether metformin should be temporarily discontinued before the CT scan and when it can be safely resumed.

C) Report of client’s sobriety for the last five years: The client’s sobriety status for the last five years is not directly relevant to the CT scan with contrast for evaluating pulmonary embolism. While substance use history is important for overall health assessment, it does not specifically require follow-up related to the CT scan.

D) Metal hip prosthesis was placed twenty years ago: The presence of a metal hip prosthesis placed twenty years ago may be relevant for certain imaging studies, such as magnetic resonance imaging (MRI) or metal artifact reduction sequence (MARS) MRI, but it is not directly related to the CT scan with contrast for pulmonary embolism evaluation. Therefore, it does not require immediate follow-up by the nurse in this context.

A) Taking the medication one hour after meals and other medications may help prevent interference with the absorption of nutrients or other medications. However, it is not a specific instruction related to the administration of bulk-forming laxatives.

B) Remaining upright for thirty minutes following drug administration is a common instruction for medications that may cause esophageal irritation or reflux. However, it is not typically necessary for bulk-forming laxatives, which work primarily in the colon rather than the esophagus or stomach.

C) Following medication administration with an additional glass of water is the correct instruction for self-administration of bulk-forming laxatives. These laxatives absorb water in the intestines, which helps to soften the stool and promote bowel movements. Adequate hydration is essential to prevent the bulk-forming laxative from causing intestinal obstruction.

D) Avoiding the intake of dairy products while using the medication is not a specific instruction related to the administration of bulk-forming laxatives. Bulk-forming laxatives are generally well-tolerated and do not interact with dairy products. However, increasing fluid intake, particularly water, is essential to prevent constipation and ensure the effectiveness of the medication.