A client with diabetes is prescribed metformin (Glucophage). Which instruction should the nurse include in the teaching plan?

Correct Answer: A

Rationale: Metformin lowers blood glucose by reducing hepatic production and improving insulin sensitivity, best taken with meals to minimize GI upset (e.g., nausea), a common side effect, while aligning with food intake for glycemic control. Reporting muscle pain relates to rare lactic acidosis, not a primary instruction unless symptomatic. Avoiding carbohydrates is incorrect'diabetes management balances carbs, not eliminates them. Bedtime-only dosing ignores twice-daily norms. Taking it with meals enhances tolerance and efficacy, critical for adherence in type 2 diabetes, where metformin is first-line. This instruction reflects its pharmacokinetics and practical use, making A the key teaching point.

Correct Answer: C

Rationale: Naloxone is a medication used to reverse the effects of an opioid overdose. It works by binding to the opioid receptors in the brain, displacing the opioids and temporarily reversing their effects. Naloxone is commonly administered in emergency situations to quickly restore normal breathing and consciousness in individuals who have overdosed on opioids. Aspirin (choice A) and Advil (choice B) are non-opioid pain relievers and do not reverse the effects of an opioid overdose. Ondansetron (choice D) is an anti-nausea medication and does not counteract the respiratory depression caused by opioid overdose.

Correct Answer: D

Rationale: In severe renal failure, the clearance of digoxin is reduced, requiring smaller maintenance doses to avoid toxicity.

Correct Answer: D

Rationale: Meperidine, a synthetic opioid, causes physical dependence with chronic use. Abrupt cessation triggers classic opioid withdrawal: anxiety, sweating, abdominal pain, diarrhea (8-12 hours onset), escalating to rhinorrhea, lacrimation, yawning, and muscle cramps—matching the timeline and symptoms described. Alprazolam (benzodiazepine) withdrawal peaks later (days), with seizures and anxiety but less GI distress. Amphetamine withdrawal causes fatigue and depression, not this autonomic profile. Ethanol withdrawal includes tremors and seizures, typically 12-48 hours, differing from this rapid onset. Secobarbital (barbiturate) withdrawal resembles benzodiazepines, with delayed seizures. Meperidine's mu receptor agonism explains the dependence and acute, opioid-specific withdrawal syndrome, aligning perfectly with the patient's presentation.

Correct Answer: D

Rationale: Post-appendectomy pain management often combines opioids like morphine with NSAIDs for synergy. Acetaminophen is an analgesic but not a true NSAID (lacks significant anti-inflammatory action). Celecoxib , a COX-2 inhibitor, is less common acutely due to cost and milder effect. Ibuprofen is effective but less potent parenterally. Ketorolac , a potent NSAID, is widely used postsurgically-available IV/IM, it reduces inflammation and pain, complementing morphine's central action. Naproxen (E) is oral, less ideal acutely. Ketorolac's rapid onset and efficacy in reducing opioid requirements make it standard. Its short-term use minimizes GI risks, aligning with surgical protocols, distinguishing it from other options for acute postoperative pain control.

Correct Answer: B

Rationale: Beta-adrenergic blocking agents are contraindicated in patients with bradycardia, heart failure, and heart block. The drug would not be contraindicated in the other patients. The nurse should assess the patient’s medical history and contraindications before administering propranolol to ensure safe and effective treatment.

Correct Answer: D

Rationale: Before starting antidepressants, assessing for suicidal ideation is critical because depression carries a high suicide risk, and some antidepressants, especially SSRIs, may initially increase this risk in vulnerable patients. This safety concern trumps other questions in urgency, as it directly impacts immediate care planning—potentially requiring closer monitoring or hospitalization. Alcohol use affects treatment efficacy but isn't the primary safety issue. Allergies are important for drug selection but secondary to life-threatening risks. Duration of depression informs chronicity, not acute danger. The nurse must prioritize identifying suicidal thoughts to ensure patient safety, aligning with psychiatric protocols and the therapeutic delay of antidepressants (2-6 weeks), making choice D the most essential question in this context.

Correct Answer: D

Rationale: Baclofen is a muscle relaxant used to treat spasticity. Weakness is a potential side effect and should be reported to the physician, as it may indicate an adverse reaction or the need for dose adjustment. Limiting fluid intake is not typically recommended, and holding the medication due to diarrhea is not a standard instruction. While alcohol can enhance the sedative effects of baclofen, the primary concern is monitoring for weakness, which could impact the patient's safety and mobility.

Correct Answer: D

Rationale: Mefenamic acid is not a phenylpropionic derivative. It is classified as a fenamate, structurally related to fenamic acid. The other options (A. ibuprofen, B. fenoprofen, C. naproxen) are all examples of phenylpropionic derivatives, commonly referred to as propionic acids. These drugs have similar chemical structures and mechanisms of action, making them a distinct group within the nonsteroidal anti-inflammatory drug (NSAID) class.