A nurse is caring for a client who is postoperative following a mitral balloon valvuloplasty.
Which of the following areas should the nurse auscultate to assess the mitral area of the heart?

Choice A rationale

Metformin extended-release tablets are designed with a special matrix that releases the medication gradually over time. Crushing or chewing the tablet would destroy this matrix, leading to an immediate and potentially unsafe release of the entire dose. This could cause a sudden drop in blood glucose and increase the risk of adverse gastrointestinal side effects.

Choice B rationale

Metformin is typically recommended to be taken with the evening meal to minimize gastrointestinal side effects such as nausea and diarrhea, which are common when starting the medication. Taking it in the morning on an empty stomach could increase the severity of these adverse effects due to the rapid concentration increase in the gastrointestinal tract.

Choice C rationale

Metformin is not associated with weight gain; in fact, it is often associated with a small amount of weight loss. This is due to its effect on reducing appetite and its ability to improve insulin sensitivity, which can help regulate metabolism and prevent the weight gain often seen with other diabetes medications.

Choice D rationale

Metformin is best taken with a meal to enhance its absorption and to mitigate common gastrointestinal side effects. Taking it on an empty stomach can increase the likelihood and severity of adverse effects like nausea, vomiting, and diarrhea because the medication can directly irritate the gastrointestinal mucosa

Choice A rationale

Increased head circumference is an unexpected finding in a newborn exposed to cocaine in utero. Cocaine is a potent vasoconstrictor, which reduces blood flow and oxygen to the developing fetus, potentially leading to intrauterine growth restriction, which would more likely result in a smaller head circumference, not a larger one. This is due to compromised fetal oxygenation and nutrient delivery.

Choice B rationale

Hypotonicity, or decreased muscle tone, is not a typical finding. Neonates exposed to cocaine in utero often exhibit hypertonicity and a rigid posture due to central nervous system excitability. This increased muscle tone is a common neurological manifestation resulting from the drug's stimulatory effects on the developing nervous system, leading to hyperirritability and tremors.

Choice C rationale

Irritability is a very common finding in a newborn exposed to cocaine throughout pregnancy. Cocaine is a potent central nervous system stimulant, and its effects on the developing fetal brain can lead to long-term neurological and behavioral issues. After birth, the neonate experiences withdrawal symptoms, resulting in excessive crying, high-pitched cries, tremors, and a state of hypervigilance.

Choice D rationale

A decreased auditory startle response is not an expected finding. Newborns exposed to cocaine often exhibit an increased and exaggerated startle response to various stimuli, including auditory cues. This hyperresponsiveness is a manifestation of the generalized central nervous system excitability caused by the chronic prenatal exposure to the potent sympathomimetic effects of cocaine on the brain. *.