Which of the following adverse effects is specific to the biguanide diabetic drug metformin (Glucophage) therapy?

Correct Answer: B

Rationale: Metformin (Glucophage) is a biguanide medication used to manage type 2 diabetes. While it is generally well-tolerated, one of its rare but serious adverse effects is lactic acidosis, a condition characterized by the buildup of lactic acid in the bloodstream. This can occur in patients with renal impairment or other risk factors. Hypoglycemia is uncommon with metformin alone, and GI distress, though common, is not life-threatening. Somnolence is not typically associated with metformin. Therefore, lactic acidosis is the most specific and serious adverse effect.

Correct Answer: B

Rationale: Aspirin, or acetylsalicylic acid, is metabolized to salicylic acid and acetic acid, not acetone, making the hydrolysis statement false. At low doses, it follows first-order kinetics, where elimination rate is proportional to concentration, a true statement reflecting its predictable clearance under therapeutic levels. It's primarily conjugated in the liver (e.g., to salicyluric acid), but excreted mainly via urine, not bile, so that's false. Aspirin irreversibly inhibits cyclooxygenase (COX) by acetylating it, unlike reversible NSAIDs, making that option false. The correct answer highlights aspirin's pharmacokinetic behavior at low doses, critical for its use in analgesia or cardioprotection, where steady-state effects depend on consistent elimination, contrasting with zero-order kinetics at overdose levels.

Correct Answer: A

Rationale: Finasteride, a 5-alpha reductase inhibitor, is prescribed as Proscar for benign prostatic hyperplasia (BPH) but also as Propecia for male pattern baldness, reducing dihydrotestosterone levels to slow hair loss. Without a prostate disorder, baldness becomes a plausible alternative indication. Erectile dysfunction isn't treated by finasteride-it may even cause it as a side effect-making that question irrelevant. Stomach ulcers and high blood pressure have no connection to finasteride's mechanism, which targets androgen pathways, not gastrointestinal or cardiovascular systems. Asking about baldness aligns with finasteride's dual use, probing a condition tied to its action on hair follicles, offering a logical explanation for its prescription in the absence of BPH, and guiding the nurse's understanding of the client's treatment rationale.

Correct Answer: C

Rationale: Chronic renal failure impairs kidney excretion, critical for drugs cleared renally-like metformin-raising toxicity risk if doses aren't adjusted, a targeted concern. Liver compensation aids metabolism, not excretion, so effectiveness isn't assured. Toxicity from all drugs assumes universal renal clearance, too broad. Decreased effectiveness ignores accumulation risks. Assessing for renal-excreted drugs' toxicity aligns with kidney function's role, ensuring safety by checking specific drug profiles.

Correct Answer: D

Rationale: Teratogenic drugs (e.g., thalidomide) cause fetal harm, absolute no-go in pregnancy, per safety. Category A is safe (e.g., levothyroxine). Category B has no human risk (e.g., metformin). ‘Cautionary' isn't a class-teratogenic fits X or known risks. Refusing teratogens protects the fetus, a clear rule.