A nurse is caring for a client who is taking valproic acid for seizure control. For which of the following adverse effects should the nurse monitor and report?

Choice A rationale:

The statement, "I will take the medication in the morning," indicates lack of understanding. Metformin is usually taken with large meals, and taking it in the morning is not the best timing.

Choice B rationale:

The statement, "I will expect to gain weight," is incorrect. Weight gain is not an expected side effect of metformin. In fact, metformin is often associated with weight loss or weight maintenance, especially in individuals with diabetes, as it helps improve insulin sensitivity and glucose metabolism.

Choice C rationale:

The statement, "I will take the medication on an empty stomach," is incorrect for extended-release metformin tablets. Unlike immediate-release metformin, extended-release tablets should be taken with meals to reduce the risk of gastrointestinal side effects.

Choice D rationale:

The statement, "I will avoid crushing this medication," is correct. Metformin extended-release tablets should never be crushed or broken, as it can affect the way the medication is released into the body. Crushing or breaking the tablet can lead to a sudden release of a large amount of metformin, potentially causing an overdose.

Choice A rationale:

Limiting each of the client's visitors to 2 hours per day is not a necessary precaution for a client undergoing brachytherapy with a low-dose radiation implant. The duration of visitor stays does not directly impact the effectiveness of the treatment or the safety of the client.

Choice B rationale:

Instructing visitors to stay 1 m (3.3 feet) away from the client is not a standard practice for patients undergoing brachytherapy. Radiation safety protocols are in place to protect both the patient and visitors. However, the exact distance may vary based on the specific treatment and facility guidelines.

Choice C rationale:

Attaching a dosimeter to the client's gown is the correct action. A dosimeter measures the amount of radiation exposure received by the client. This information is crucial for healthcare providers to monitor the client's radiation dose, ensuring it stays within safe limits and effectively targets the cancer cells.

Choice D rationale:

Straining the client's urine is not directly related to brachytherapy with a low-dose radiation implant. This intervention is more relevant in situations where kidney stones or other urinary obstructions are suspected. It is not a standard practice for patients undergoing brachytherapy.