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:
Nausea, vomiting, diarrhea
Palpitations
Headaches
Heartburn
The Correct Answer is A
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: The initial phase of drug distribution is not the correct definition of the term 'first pass effect'. Drug distribution is the process by which a drug moves from the bloodstream to the tissues and organs of the body. The initial phase of drug distribution is influenced by factors such as blood flow, tissue permeability, plasma protein binding, and tissue binding. The first pass effect is not related to drug distribution, but to drug metabolism, which is the chemical transformation of a drug in the body.
Choice B reason: The rapid absorption of a drug in the intestine is not the correct definition of the term 'first pass effect'. Drug absorption is the process by which a drug enters the bloodstream from the site of administration. The rapid absorption of a drug in the intestine depends on factors such as the drug formulation, the pH of the gastrointestinal tract, the presence of food or other drugs, and the surface area and motility of the intestine. The first pass effect is not related to drug absorption, but to drug metabolism, which is the chemical transformation of a drug in the body.
Choice C reason: The initial rapid excretion of a drug through the urinary system is not the correct definition of the term 'first pass effect'. Drug excretion is the process by which a drug or its metabolites are eliminated from the body. The initial rapid excretion of a drug through the urinary system is influenced by factors such as the renal blood flow, the glomerular filtration rate, the tubular secretion and reabsorption, and the urine pH. The first pass effect is not related to drug excretion, but to drug metabolism, which is the chemical transformation of a drug in the body.
Choice D reason: The metabolism of a drug before it reaches the systemic circulation is the correct definition of the term 'first pass effect'. Drug metabolism is the process by which a drug is chemically transformed in the body, usually by enzymes in the liver or other tissues. The first pass effect is a phenomenon of drug metabolism that occurs when a drug is administered orally and passes through the gastrointestinal tract and the liver before reaching the systemic circulation. The first pass effect can reduce the bioavailability and the effectiveness of the drug, as some or most of the drug may be metabolized and inactivated before reaching the site of action.
Correct Answer is C
Explanation
Choice A reason: Past medical history of benign prostatic hyperplasia (BPH) is not a contraindication or a concern for administering Reglan, which is a medication that stimulates the motility of the upper gastrointestinal tract and treats nausea, heartburn, and gastroparesis¹. Reglan does not affect the prostate or urinary function.
Choice B reason: Blood pressure of 132/82 is slightly above the normal range of 120/80, but it is not a cause for concern or a reason to withhold Reglan. Reglan can lower the blood pressure by reducing the fluid volume and preventing sodium retention¹. The nurse should monitor the blood pressure regularly, but does not need to notify the health care provider about this finding.
Choice C reason: Allergy to corn is a concern for administering Reglan, as some formulations of Reglan may contain corn starch as an inactive ingredient. Corn starch can trigger an allergic reaction in people who are sensitive to corn, causing symptoms such as rash, itching, swelling, or anaphylaxis. The nurse should check the label of the Reglan product and avoid using it if it contains corn starch. The nurse should also notify the health care provider and the pharmacy about the patient's allergy and request an alternative medication or formulation.
Choice D reason: Past medical history of gout is not a contraindication or a concern for administering Reglan, which is a medication that stimulates the motility of the upper gastrointestinal tract and treats nausea, heartburn, and gastroparesis¹. Reglan does not affect the uric acid levels or the joints.
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