The nurse is caring for a client who is refusing to take their prescribed metformin (Glucophage). The nurse understands that the most common side effects of metformin are:

Choice A reason: This is correct. The liver is the main organ responsible for drug metabolism. The enzymes that the body uses to metabolize drugs are present throughout the body but are most abundant in the liver. The liver can transform drugs into more polar and water-soluble compounds, which can then be excreted by the kidneys or the biliary system.

Choice B reason: This is incorrect. The lungs are not primarily responsible for drug metabolism, although they can play a minor role in some cases. The lungs can metabolize some drugs that are inhaled, such as anesthetics, or drugs that circulate through the pulmonary blood vessels, such as propranolol. However, the lungs have a lower capacity and a lower variety of enzymes than the liver.

Choice C reason: This is incorrect. The heart is not responsible for drug metabolism, although it can be affected by it. The heart is the organ that pumps blood throughout the body, delivering oxygen and nutrients to the tissues and organs. The heart can be influenced by the pharmacokinetics and pharmacodynamics of drugs, which are the processes of drug absorption, distribution, metabolism, and excretion, and the effects of drugs on the body, respectively.

Choice D reason: This is incorrect. The kidney is not primarily responsible for drug metabolism, although it is important for drug excretion. The kidney is the organ that filters the blood and removes waste products and excess fluid as urine. The kidney can excrete drugs that are water-soluble or that are not reabsorbed by the tubules. The kidney can also metabolize some drugs, such as aspirin, but to a lesser extent than the liver.

Choice A reason: This is correct. Hypertension is a contraindication for taking pseudoephedrine. Pseudoephedrine is a decongestant that shrinks the blood vessels in the nasal passages and relieves congestion. However, it can also increase the blood pressure and the heart rate, which can worsen hypertension and increase the risk of stroke, heart attack, or kidney damage. The nurse should advise the client to avoid pseudoephedrine and use other methods to relieve sinus congestion, such as saline nasal spray, steam inhalation, or humidifier.

Choice B reason: This is incorrect. Diverticulitis is not a contraindication for taking pseudoephedrine. Diverticulitis is a condition where small pouches in the colon become inflamed and infected. It can cause symptoms such as abdominal pain, fever, nausea, or constipation. Pseudoephedrine does not affect the colon or the inflammation directly, but it can cause dehydration, which can worsen constipation and diverticulitis. The nurse should advise the client to drink plenty of fluids and eat a highfiber diet to prevent constipation and diverticulitis.

Choice C reason: This is incorrect. Migraines are not a contraindication for taking pseudoephedrine. Migraines are severe headaches that are often accompanied by nausea, vomiting, or sensitivity to light and sound. They can be triggered by various factors, such as stress, hormones, or food. Pseudoephedrine does not cause migraines directly, but it can interact with some migraine medications, such as triptans, which are used to treat acute migraine attacks. The combination of pseudoephedrine and triptans can increase the blood pressure and the risk of serotonin syndrome, a serious condition that causes agitation, confusion, tremors, or seizures. The nurse should advise the client to check with their doctor before taking pseudoephedrine and triptans together.

Choice D reason: This is incorrect. Eczema is not a contraindication for taking pseudoephedrine. Eczema is a skin condition that causes dry, itchy, and inflamed skin. It can be caused by various factors, such as allergies, irritants, or genetics. Pseudoephedrine does not affect the skin or the inflammation directly, but it can cause dryness of the mucous membranes, such as the mouth, nose, or eyes. The nurse should advise the client to use a moisturizer, a lip balm, and artificial tears to prevent dryness and irritation of the skin and the mucous membranes.