After administering sublingual nitroglycerin to a client with chest pain, it is most important for the nurse to assess:

Choice A reason: This is correct. Drinking a glass of water after taking calcium carbonate antacid can help flush the medication down the esophagus and into the stomach, where it can neutralize the excess acid. It can also prevent the medication from sticking to the esophagus and causing irritation or damage¹.

Choice B reason: This is incorrect. Decreasing bulk in the diet is not necessary when taking calcium carbonate antacid. In fact, increasing fiber intake can help prevent constipation, which is a common side effect of calcium carbonate antacid. Constipation occurs because calcium carbonate can reduce the motility of the gastrointestinal tract.

Choice C reason: This is incorrect. Taking the medication with dairy products can decrease absorption and effectiveness of calcium carbonate antacid. Dairy products contain calcium, which can bind to calcium carbonate and form insoluble complexes that are not absorbed by the body. This can reduce the amount of calcium carbonate available to neutralize the stomach acid.

Choice D reason: This is incorrect. Reducing sodium intake is not related to taking calcium carbonate antacid. Sodium is a mineral that regulates fluid balance, blood pressure, and nerve and muscle function in the body. Some medications, such as diuretics, can increase sodium excretion and require the patient to limit sodium intake. Calcium carbonate antacid is not one of them.

Choice A reason: This is correct. Nausea, vomiting, and diarrhea are the most common side effects of metformin, especially when the drug is started or the dose is increased. These side effects occur because metformin can interfere with the absorption of glucose and other nutrients in the intestines, causing osmotic diarrhea. The nurse should advise the client to take metformin with food, start with a low dose and gradually increase it, and drink plenty of fluids to prevent dehydration. The nurse should also monitor the client for signs of lactic acidosis, a rare but serious complication of metformin that causes severe diarrhea, abdominal pain, muscle cramps, and difficulty breathing.

Choice B reason: This is incorrect. Palpitations are not a common side effect of metformin. Palpitations are the sensation of a rapid, irregular, or pounding heartbeat, which can be caused by various factors, such as stress, anxiety, caffeine, nicotine, or heart problems. Metformin does not affect the heart rate or rhythm directly, but it can lower the blood sugar levels, which can trigger the release of adrenaline, a hormone that can cause palpitations. The nurse should check the client's blood sugar levels and advise the client to eat regular meals and snacks, avoid alcohol and caffeine, and report any chest pain or shortness of breath.

Choice C reason: This is incorrect. Headaches are not a common side effect of metformin. Headaches are the pain or discomfort in the head, scalp, or neck, which can be caused by various factors, such as stress, dehydration, or sinus infection. Metformin does not cause headaches directly, but it can lower the blood sugar levels, which can cause headaches as a symptom of hypoglycemia. The nurse should check the client's blood sugar levels and advise the client to eat regular meals and snacks, drink plenty of water, and take painkillers as needed.

Choice D reason: This is incorrect. Heartburn is not a common side effect of metformin. Heartburn is the burning sensation in the chest or throat, which is caused by the reflux of stomach acid into the esophagus. Metformin does not cause heartburn directly, but it can worsen it if the client already has gastroesophageal reflux disease (GERD), a condition where the lower esophageal sphincter is weak or relaxed and allows the acid to flow back. The nurse should advise the client to take metformin with food, avoid spicy or fatty foods, elevate the head of the bed, and take antacids as needed.