A nurse is obtaining a medical history from a client who has a new diagnosis of type 2 diabetes mellitus. The nurse should report which of the following conditions is a contraindication for the use of metformin?

A. Discuss the incident with the health care worker: While addressing the suspected impairment with the worker is important, immediate removal from the work environment takes priority to ensure patient safety and prevent potential harm. Confrontation can follow after securing a safe environment.

B. Document the findings of the incident: Documentation is essential for legal and professional accountability, but it is secondary to protecting patients from immediate risk. Recording observations does not prevent ongoing exposure to unsafe practice.

C. Remove the health care worker from the work environment: The first priority is ensuring patient safety. Suspected chemical impairment can impair judgment, coordination, and response time, creating a high risk for errors or accidents. Immediate removal prevents potential harm to clients and coworkers.

D. Place the health care worker on probation: Probation is a disciplinary measure that may follow an investigation, but it is not the first step. Immediate action must focus on safety, and probation does not address the urgent risk posed by active impairment.

A. Protruding hemorrhoids: Hemorrhoids are common in late pregnancy due to increased venous pressure and straining, and while uncomfortable, they are not an urgent concern requiring immediate provider notification.

B. 3+ deep-tendon reflexes: Hyperactive reflexes (3+) can indicate potential preeclampsia, which is a serious condition characterized by hypertension and risk of seizures. This finding requires prompt reporting and further evaluation to prevent complications for both the mother and fetus.

C. Supine hypotension: Supine hypotensive syndrome can occur when a pregnant client lies on her back, causing compression of the inferior vena cava. It is typically relieved by repositioning to the left lateral side and is not immediately dangerous if addressed promptly.

D. Urinary frequency: Increased urinary frequency is common in late pregnancy due to fetal pressure on the bladder. While it may cause discomfort, it is an expected finding and does not require urgent reporting to the provider.