Which of the following is most important for the nurse to include with calcium channel blockers?

Choice A reason: Atenolol is a beta blocker that lowers blood pressure and heart rate. The nurse should hold atenolol for this client because the client's heart rate is already low (52 beats per minute), and giving atenolol could cause bradycardia (slow heart rate), which can lead to dizziness, fainting, or heart failure. The nurse should notify the provider and monitor the client's vital signs and cardiac rhythm.

Choice B reason: Captopril is an ACE inhibitor that lowers blood pressure and prevents kidney damage. The nurse should not hold captopril for this client because the client's blood pressure is still high (138/90 mmHg), and captopril could help lower it to the target range. The nurse should administer captopril as prescribed and monitor the client's blood pressure and renal function.

Choice C reason: Warfarin is an anticoagulant that prevents blood clots and reduces the risk of stroke. The nurse should not hold warfarin for this client because the client's INR (a measure of blood clotting time) is within the therapeutic range (2.0 to 3.0), and warfarin could help prevent post-operative complications such as deep vein thrombosis or pulmonary embolism. The nurse should administer warfarin as prescribed and monitor the client's INR and bleeding signs.

Choice D reason: Glipizide is not a medication for this client. Glipizide is an oral hypoglycemic agent that lowers blood sugar levels in people with diabetes. This client does not have diabetes and does not need glipizide. The nurse should check the medication order and the client's medical history and clarify any discrepancies with the provider.

Choice A reason: This choice is incorrect because glargine is not a drug that needs to be assessed before a CT scan with contrast. Glargine is a long-acting insulin that lowers blood sugar levels in people with diabetes. It is injected once a day, usually at bedtime, and works for 24 hours. The nurse should monitor the client's blood sugar levels and adjust the dose of glargine as needed, but it does not interfere with the CT scan or the contrast dye.

Choice B reason: This choice is correct because metformin is a drug that needs to be assessed before a CT scan with contrast. Metformin is an oral medication that lowers blood sugar levels in people with diabetes. It works by reducing the amount of glucose produced by the liver and increasing the sensitivity of the cells to insulin. However, metformin can cause a rare but serious condition called lactic acidosis, which is a buildup of lactic acid in the blood that can cause symptoms such as nausea, vomiting, abdominal pain, muscle weakness, and breathing problems. The risk of lactic acidosis is increased when metformin is combined with contrast dye, which can affect the kidney function and the clearance of metformin from the body. The nurse should check the client's kidney function and the dose and timing of metformin before the CT scan. The nurse should also instruct the client to stop taking metformin before and after the CT scan, as directed by the provider.

Choice C reason: This choice is incorrect because famotidine is not a drug that needs to be assessed before a CT scan with contrast. Famotidine is an antacid that reduces the amount of acid in the stomach. It is used to treat conditions such as gastroesophageal reflux disease (GERD), ulcers, and gastritis. It does not affect the blood sugar levels or the kidney function, and it does not interact with the contrast dye. The nurse should administer famotidine as prescribed and monitor the client's gastrointestinal symptoms, but it does not require any special precautions before the CT scan.

Choice D reason: This choice is incorrect because glucagon is not a drug that needs to be assessed before a CT scan with contrast. Glucagon is a hormone that raises blood sugar levels in people with diabetes. It is used as an emergency treatment for severe hypoglycemia (low blood sugar), when the person is unconscious or unable to swallow. It is injected into a muscle or under the skin, and it works by stimulating the liver to release glucose into the blood. The nurse should have glucagon available in case of hypoglycemia, but it does not affect the CT scan or the contrast dye.