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
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Monitor the patient for addiction is not a necessary measure for the nurse to take when administering codeine cough syrup, which is a medication that suppresses the cough reflex by acting on the brain¹. Codeine is a Schedule V medication, which means that it has a low potential for abuse and dependence compared to other opioids. The nurse should follow the prescriber's order and the label instructions and use the lowest effective dose for the shortest duration. The nurse should also assess the patient's pain level, respiratory status, and cough frequency and severity.
Choice B reason: Advise the patient that the medication helps to thin out their secretions is an incorrect statement for the nurse to make when administering codeine cough syrup, which is a medication that suppresses the cough reflex by acting on the brain¹. Codeine does not affect the viscosity or production of the mucus in the airways, but rather reduces the urge to cough. The nurse should advise the patient to drink plenty of fluids, use a humidifier, or use saline nasal spray to help loosen and clear the secretions.
Choice C reason: Advise the patient to minimize intake of beets is not a relevant measure for the nurse to take when administering codeine cough syrup, which is a medication that suppresses the cough reflex by acting on the brain¹. Beets are a vegetable that are rich in antioxidants, fiber, and nitrates, which can lower blood pressure and improve blood flow. Beets do not interact with codeine or affect its metabolism or clearance. The nurse should encourage the patient to eat a balanced and nutritious diet, unless they have any dietary restrictions or allergies.
Choice D reason: Advise the patient that constipation is an adverse effect of the medication is the correct and appropriate measure for the nurse to take when administering codeine cough syrup, which is a medication that suppresses the cough reflex by acting on the brain¹. Codeine can also act on the opioid receptors in the gastrointestinal tract, which can reduce the peristalsis and cause constipation. The nurse should advise the patient to prevent or treat constipation by increasing their fluid and fiber intake, exercising regularly, and using laxatives or stool softeners as needed.
Correct Answer is D
Explanation
Choice A reason: Monoamine oxidase inhibitors (MAOIs) are not the correct class of medications to which escitalopram (Lexapro) belongs. MAOIs are a group of antidepressants that work by inhibiting the enzyme monoamine oxidase, which breaks down neurotransmitters such as serotonin, norepinephrine, and dopamine. MAOIs can increase the levels of these neurotransmitters in the brain and improve mood and energy. However, MAOIs can also cause serious side effects and interactions with other drugs and foods, and they are not commonly used as firstline treatment for depression. Escitalopram is not an MAOI, and it should not be taken with MAOIs or within 14 days of stopping or starting MAOIs, as this can cause a dangerous drug interaction called serotonin syndrome.
Choice B reason: Betablockers are not the correct class of medications to which escitalopram (Lexapro) belongs. Betablockers are a group of drugs that work by blocking the beta receptors on the heart and blood vessels, which are stimulated by adrenaline and noradrenaline. Betablockers can lower the heart rate, blood pressure, and cardiac output, and they are used to treat conditions such as hypertension, angina, arrhythmias, and heart failure. Betablockers can also reduce anxiety and tremors, but they are not antidepressants and they do not affect serotonin levels. Escitalopram is not a betablocker, and it does not have any significant effect on the cardiovascular system.
Choice C reason: Benzodiazepines are not the correct class of medications to which escitalopram (Lexapro) belongs. Benzodiazepines are a group of drugs that work by enhancing the activity of the neurotransmitter gammaaminobutyric acid (GABA), which has a calming and sedating effect on the brain. Benzodiazepines are used to treat anxiety, insomnia, seizures, and muscle spasms, and they can also cause relaxation, drowsiness, and amnesia. Benzodiazepines are not antidepressants and they do not affect serotonin levels. Escitalopram is not a benzodiazepine, and it does not have any significant effect on GABA receptors .
Choice D reason: Selective serotonin reuptake inhibitors (SSRIs) are the correct class of medications to which escitalopram (Lexapro) belongs. SSRIs are a group of antidepressants that work by blocking the reuptake of serotonin by the nerve cells, which increases the availability of serotonin in the synaptic cleft. Serotonin is a neurotransmitter that regulates mood, appetite, sleep, and cognition, and low levels of serotonin are associated with depression and anxiety. SSRIs can improve the symptoms of depression and anxiety by enhancing the serotonin signaling in the brain. Escitalopram is an SSRI, and it is used to treat major depressive disorder and generalized anxiety disorder.
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