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: Dextromethorphan (Robitussin) is not the correct medication for a patient with a productive cough. Dextromethorphan is a cough suppressant that works by acting on the brain to reduce the cough reflex. Dextromethorphan is used for a dry, nonproductive cough that is caused by irritation or inflammation. Dextromethorphan is not effective for a productive cough that produces mucus, and it may even be harmful by preventing the clearance of secretions from the lungs.

Choice B reason: Fluticasone (Flonase) is not the correct medication for a patient with a productive cough. Fluticasone is a corticosteroid that works by reducing inflammation and swelling in the nasal passages. Fluticasone is used for allergic rhinitis, which is a condition that causes sneezing, itching, and runny nose due to an allergic reaction. Fluticasone is not effective for a productive cough that produces mucus, and it may even worsen it by suppressing the immune system and increasing the risk of infection.

Choice C reason: Pseudoephedrine (Sudafed) is not the correct medication for a patient with a productive cough. Pseudoephedrine is a decongestant that works by constricting the blood vessels in the nasal passages and sinuses. Pseudoephedrine is used for nasal congestion, which is a condition that causes stuffy nose and difficulty breathing due to swelling of the mucous membranes. Pseudoephedrine is not effective for a productive cough that produces mucus, and it may even cause side effects such as increased blood pressure, insomnia, and anxiety.

Choice D reason: Guaifenesin (Mucinex) is the correct medication for a patient with a productive cough. Guaifenesin is an expectorant that works by thinning and loosening the mucus in the chest and throat. Guaifenesin is used for a productive cough that produces mucus, as it helps the cough to be more effective and clear the airways. Guaifenesin is generally safe and well tolerated, but it may cause some minor side effects such as nausea, vomiting, and headache.

A. Relief of heartburn B. Cessation of diarrhea C. Passage of flatus D. Absence of constipation

Correct Answer is A

Explanation

Choice A reason: Relief of heartburn is the correct outcome that indicates that famotidine is therapeutic. Famotidine is a medication that belongs to the class of H2 receptor antagonists, which work by blocking the action of histamine on the H2 receptors of the stomach cells, thereby reducing the production of gastric acid. Famotidine is used to treat and prevent conditions such as gastroesophageal reflux disease (GERD), peptic ulcer disease, and Zollinger Ellison syndrome, which are characterized by excessive acid secretion and irritation of the esophagus and stomach. Famotidine can relieve the symptoms of heartburn, which is a burning sensation in the chest or throat caused by the reflux of stomach acid into the esophagus.

Choice B reason: Cessation of diarrhea is not an outcome that indicates that famotidine is therapeutic. Famotidine is a medication that belongs to the class of H2 receptor antagonists, which work by blocking the action of histamine on the H2 receptors of the stomach cells, thereby reducing the production of gastric acid. Famotidine does not affect the motility or secretion of the intestines, and it is not used to treat diarrhea, which is a condition of frequent and loose bowel movements. Diarrhea can have various causes, such as infections, medications, food intolerance, or inflammatory bowel disease, and it requires different treatments depending on the underlying cause. Famotidine is not effective for treating diarrhea, and it may even worsen it by reducing the acidity of the stomach and increasing the risk of bacterial overgrowth.

Choice C reason: Passage of flatus is not an outcome that indicates that famotidine is therapeutic. Famotidine is a medication that belongs to the class of H2 receptor antagonists, which work by blocking the action of histamine on the H2 receptors of the stomach cells, thereby reducing the production of gastric acid. Famotidine does not affect the digestion or fermentation of food in the gastrointestinal tract, and it is not used to treat flatulence, which is the accumulation and expulsion of gas from the stomach or intestines. Flatulence can have various causes, such as swallowing air, eating certain foods, or having a bacterial imbalance in the gut, and it requires different treatments depending on the underlying cause. Famotidine is not effective for treating flatulence, and it may even increase it by reducing the acidity of the stomach and altering the gut flora.

Choice D reason: Absence of constipation is not an outcome that indicates that famotidine is therapeutic. Famotidine is a medication that belongs to the class of H2 receptor antagonists, which work by blocking the action of histamine on the H2 receptors of the stomach cells, thereby reducing the production of gastric acid. Famotidine does not affect the motility or secretion of the intestines, and it is not used to treat constipation, which is a condition of infrequent or difficult bowel movements. Constipation can have various causes, such as dehydration, lack of fiber, medications, or bowel obstruction, and it requires different treatments depending on the underlying cause. Famotidine is not effective for treating constipation, and it may even cause it by reducing the acidity of the stomach and slowing down the digestion.

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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:

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Naxlex Comprehensive Predictor Exams

The nurse caring for a patient with a productive cough would anticipate an order for the following medication:

Correct Answer is D

Explanation

A nurse is taking a health history of a client who reports occasionally taking several over-the-counter medications, including an H2 receptor antagonist (famotidine). Which of the following outcomes indicates that famotidine is therapeutic?

Correct Answer is A

Explanation

Which organ is primarily responsible for excretion of a medication?

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