A nurse is assessing a client who has heart failure and a new prescription for metoprolol. Which of the following findings should the nurse identify as an adverse effect of the medication?

Choice A reason: A client with type 1 diabetes mellitus who has taken a high dose of insulin is at significant risk for hypoglycemia. In type 1 diabetes, the body does not produce insulin, so insulin therapy is essential for controlling blood glucose levels. However, if the dose of insulin is too high relative to the patient's dietary intake or physical activity level, it can lead to a rapid decrease in blood glucose levels, resulting in hypoglycemia. Hypoglycemia is defined as a blood glucose level less than 70 mg/dL (3.9 mmol/L) and can cause symptoms such as confusion, sweating, weakness, and in severe cases, seizures or loss of consciousness.

Choice B reason: A client with type 2 diabetes who has not taken any medication may have elevated blood glucose levels but is not typically at immediate risk for hypoglycemia unless they are taking medications that lower blood glucose. Type 2 diabetes is characterized by insulin resistance, and while medication can help manage it, skipping medication does not usually result in hypoglycemia unless other factors are at play.

Choice C reason: An older adult client taking an antibiotic for an infection is not generally at risk for hypoglycemia unless the antibiotic interacts with other medications that the client is taking for diabetes management. Antibiotics themselves do not typically cause hypoglycemia.

Choice D reason: A client who has metabolic syndrome and is taking a statin drug to lower cholesterol levels is not at direct risk for hypoglycemia from the statin medication. Metabolic syndrome is a cluster of conditions that increase the risk for heart disease, stroke, and type 2 diabetes. While statins are used to lower cholesterol levels, they do not have a direct impact on blood glucose levels that would lead to hypoglycemia.

Choice A reason: Moving the cane 2 feet ahead is too far and can cause imbalance or a fall. The cane should be moved a short distance ahead, about the length of one natural step.

Choice B reason: Holding the cane with the right hand is correct for someone with left-sided weakness. The cane should be used on the stronger side of the body to provide support for the weaker side.

Choice C reason : Taking a step with the left foot first is not correct because the weaker leg should be advanced to the cane to ensure stability and support when moving.

Choice D reason: Advancing the weaker leg forward to the cane is correct. The cane provides support for the weaker leg, helping to maintain balance as the client walks.