The nurse is caring for a client who is taking metformin (Glucophage) for hyperglycemia prior to admission. The nurse would question the following order for this client:

CT scan with contrast

Chest X-ray 1 view

V/Q scan

Bilateral lower extremity ultrasound

Answer and Explanation

The Correct Answer is A

Choice A reason: CT scan with contrast is an order that the nurse should question for the client who is taking metformin for hyperglycemia. Metformin is a medication that lowers the blood glucose level by decreasing the hepatic glucose production and increasing the insulin sensitivity¹. Metformin can cause a rare but serious complication called lactic acidosis, which is a buildup of lactic acid in the blood that can cause symptoms such as weakness, nausea, vomiting, or breathing problems. CT scan with contrast involves injecting iodinated contrast material into the bloodstream, which can affect the kidney function and increase the risk of lactic acidosis in patients taking metformin. The nurse should consult with the prescriber and the pharmacist about the need to stop metformin before and after the CT scan with contrast, and to monitor the kidney function and the blood glucose level of the client.

Choice B reason: Chest X-ray 1 view is not an order that the nurse should question for the client who is taking metformin for hyperglycemia. Chest X-ray is a diagnostic test that uses a small amount of radiation to produce images of the lungs, heart, and chest wall. Chest X-ray does not involve any contrast material or affect the kidney function or the blood glucose level. The nurse should follow the standard precautions and procedures for performing a chest X-ray, such as verifying the client's identity, checking for pregnancy, removing any metal objects, and positioning the client properly.

Choice C reason: V/Q scan is not an order that the nurse should question for the client who is taking metformin for hyperglycemia. V/Q scan is a diagnostic test that measures the ventilation and perfusion of the lungs, and can detect any abnormalities such as pulmonary embolism or chronic obstructive pulmonary disease. V/Q scan involves injecting a radioactive tracer into the bloodstream and inhaling a radioactive gas, which are then detected by a special camera. V/Q scan does not affect the kidney function or the blood glucose level. The nurse should follow the standard precautions and procedures for performing a V/Q scan, such as verifying the client's identity, checking for allergies, explaining the procedure, and monitoring the vital signs.

Choice D reason: Bilateral lower extremity ultrasound is not an order that the nurse should question for the client who is taking metformin for hyperglycemia. Bilateral lower extremity ultrasound is a diagnostic test that uses sound waves to produce images of the blood vessels in the legs, and can detect any abnormalities such as deep vein thrombosis or peripheral arterial disease. Bilateral lower extremity ultrasound does not involve any contrast material or affect the kidney function or the blood glucose level. The nurse should follow the standard precautions and procedures for performing a bilateral lower extremity ultrasound, such as verifying the client's identity, explaining the procedure, and applying a gel and a probe to the legs.

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Correct Answer is D

Explanation

Choice A reason: Administering the medication with meals only is not a valid adjustment for a medication that is primarily excreted by the kidneys. The food intake does not affect the renal clearance of the drug, unless it alters the pH of the urine or the blood flow to the kidneys. The nurse should follow the instructions on the medication label or the prescriber's order regarding the timing of the administration.

Choice B reason: No dose adjustment is required is an incorrect statement for a medication that is primarily excreted by the kidneys. The renal impairment can reduce the elimination of the drug and increase its concentration in the blood. This can cause adverse effects and toxicity. The nurse should consult with the prescriber or the pharmacist about the appropriate dose reduction or frequency change for the patient's level of renal function.

Choice C reason: Increasing the dose to ensure therapeutic effect is a dangerous and inappropriate adjustment for a medication that is primarily excreted by the kidneys. The renal impairment can reduce the elimination of the drug and increase its concentration in the blood. This can cause adverse effects and toxicity. The nurse should not increase the dose without the prescriber's order and should monitor the patient for signs of overdose or toxicity.

Choice D reason: Decreasing the dose to prevent toxicity is the correct and rational adjustment for a medication that is primarily excreted by the kidneys. The renal impairment can reduce the elimination of the drug and increase its concentration in the blood. This can cause adverse effects and toxicity. The nurse should consult with the prescriber or the pharmacist about the appropriate dose reduction or frequency change for the patient's level of renal function. The nurse should also monitor the patient for the therapeutic response and the adverse effects of the drug.

A. Drink a glass of water after taking the medication. B. Decrease bulk in the diet to counteract the adverse effect of diarrhea. C. Take the medication with dairy products to increase absorption. D. Reduce sodium intake.

Correct Answer is A

Explanation

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.

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The nurse is caring for a client who is taking metformin (Glucophage) for hyperglycemia prior to admission. The nurse would question the following order for this client:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A patient with renal impairment is prescribed a medication that is primarily excreted by the kidneys. What adjustment should the nurse anticipate?

Correct Answer is D

Explanation

A nurse is completing a medication history for a client who reports using over-the-counter calcium carbonate antacid. Which of the following recommendations should the nurse make about taking this medication?

Correct Answer is A

Explanation

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