An older adult client has been prescribed metformin for the treatment of type 2 diabetes for several years. Which change in the client's laboratory values may demonstrate a need to discontinue the medication?
An increase in serum lactate
A decrease in hemoglobin and hematocrit
An increase in white blood cells
A decrease in potassium accompanied by an increase in sodium
The Correct Answer is A
A. An increase in serum lactate – This is a critical laboratory value that can indicate lactic acidosis, a serious side effect associated with metformin, especially in older adults or those with renal impairment. An increase in serum lactate necessitates discontinuation of the medication.
B. A decrease in hemoglobin and hematocrit – While this change may indicate anemia, it is not directly associated with the need to discontinue metformin. Further evaluation of the cause of anemia would be necessary.
C. An increase in white blood cells – This could indicate an infection or inflammatory process but does not specifically necessitate the discontinuation of metformin.
D. A decrease in potassium accompanied by an increase in sodium – While electrolyte imbalances should be monitored, this change does not directly indicate that metformin should be discontinued.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Weekly – This frequency is too frequent for dosage adjustments of levothyroxine. Adjustments are generally made less frequently to allow for the medication to reach therapeutic levels.
B. Monthly – While some adjustments may be made on a monthly basis, this is not the typical recommendation.
C. Every 3 to 5 days – This is also too frequent for dosage adjustments as it may not allow enough time to assess the effects of the current dose.
D. Every 4 to 6 weeks – This is the correct recommendation for adjusting levothyroxine dosages. After starting therapy or adjusting the dose, it is advised to wait 4 to 6 weeks before evaluating thyroid function tests and making any further adjustments to the dosage, as it takes time for the medication to take effect.
Correct Answer is D
Explanation
This intervention is important to ensure accurate dosing and prevent medication errors. Insulin is a high-alert medication, meaning that it has a high potential for causing significant harm to the patient if administered incorrectly. Doublechecking the insulin dosage with a colleague can help prevent errors in dosing, which could lead to hypoglycemia or hyperglycemia in the client. It is also important to confirm the dosage since insulin dosing is based on individualized factors such as the client's blood glucose levels, weight, and overall health status.
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