Correct Answer: C

Rationale: Monitoring for signs of lactic acidosis, such as muscle pain, weakness, or difficulty breathing, is critical, as it is a rare but serious side effect of metformin that requires immediate medical attention.
Choice A is wrong because, while taking metformin with meals can reduce gastrointestinal upset, the nurse should also advise starting with a low dose and gradually increasing to minimize side effects, not just taking it with meals.
Choice B is wrong because metformin is not typically associated with weight gain; it is weight-neutral or may promote slight weight loss.
Choice D is wrong because taking an additional dose after missing one is incorrect; the client should take the missed dose as soon as remembered unless it's close to the next dose, and consult the provider for guidance.

Correct Answer: A

Rationale: Crepitus (grating or crunching sound) with joint movement is a common finding in osteoarthritis due to cartilage degeneration and bone-on-bone contact.
Choice B is incorrect because osteoarthritis typically causes asymmetrical joint swelling, unlike rheumatoid arthritis, which is symmetrical.
Choice C is incorrect because morning stiffness in osteoarthritis is brief (less than 30 minutes), unlike rheumatoid arthritis, where it lasts longer (e.g., 2 hours).
Choice D is incorrect because fever is not a feature of osteoarthritis unless there is an infection or another condition.

Correct Answer: A

Rationale: A non-tender, protruding abdomen is a normal finding for a 2-year-old toddler. This is due to the immature development of the abdominal muscles and the relatively large size of the liver and kidneys in relation to the rest of the body.
Choice B is wrong because the head circumference should be equal to or less than the chest circumference by age 2. A head circumference that exceeds the chest circumference could indicate hydrocephalus or other neurological problems.
Choice C is wrong because the fontanels, or soft spots on the skull, should be closed by the age of 18 months. Palpable fontanels could indicate dehydration, malnutrition, or congenital disorders.
Choice D is wrong because the natural loss of deciduous teeth, or baby teeth, usually begins around age 6. Premature loss of teeth could indicate dental caries, trauma, or endocrine disorders.

Correct Answer: A

Rationale: Applying a cold pack to the surgical site for the first 24 hours reduces swelling and pain, promoting comfort and recovery after total knee arthroplasty.
Choice B is incorrect because keeping the affected leg in a dependent position increases swelling; the leg should be elevated to reduce edema.
Choice C is incorrect because active range-of-motion exercises are typically started later (e.g., day 2 or 3), with passive or assisted exercises on day 1 to avoid strain.
Choice D is incorrect because heparin is usually given subcutaneously (e.g., enoxaparin) for DVT prophylaxis, not IV, and the duration depends on the provider's protocol, not automatically 7 days.

Correct Answer: B

Rationale: Avoiding alcohol is critical while taking methotrexate, as alcohol increases the risk of hepatotoxicity, a serious side effect of this immunosuppressive drug used for rheumatoid arthritis.
Choice A is incorrect because methotrexate can be taken with or without food, but a high-fat meal is not specifically recommended and may not affect absorption.
Choice C is incorrect because methotrexate takes weeks to months to relieve joint pain; it is not an immediate-acting analgesic.
Choice D is incorrect because methotrexate is typically taken once weekly (not daily at bedtime) to reduce systemic toxicity, and timing is flexible.