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A patient with a history of type 2 diabetes mellitus is prescribed metformin therapy. Which adverse effect is associated with metformin use and requires immediate medical attention?
- A. Hypoglycemia
- B. Lactic acidosis
- C. Hyperkalemia
- D. Peripheral neuropathy
Correct Answer: B
Rationale: Metformin is a commonly prescribed medication for the treatment of type 2 diabetes mellitus. One of the rare but serious adverse effects associated with metformin use is lactic acidosis. Lactic acidosis results from the buildup of lactic acid in the bloodstream, leading to symptoms such as weakness, rapid breathing, abdominal pain, and muscle pain. Lactic acidosis can be life-threatening and requires immediate medical attention. It is important for patients taking metformin to be aware of the signs and symptoms of lactic acidosis and seek immediate medical help if they experience any of these symptoms. Regular monitoring of kidney function is crucial in patients taking metformin to reduce the risk of lactic acidosis.
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A patient is prescribed a calcium channel blocker for the management of hypertension. Which adverse effect should the nurse monitor closely in the patient?
- A. Hypoglycemia
- B. Peripheral edema
- C. Hypokalemia
- D. Tachycardia
Correct Answer: D
Rationale: Calcium channel blockers are often prescribed for the management of hypertension because they can help relax blood vessels and slow the heart rate, thus reducing blood pressure. One of the major adverse effects associated with calcium channel blockers is bradycardia (slow heart rate) or even more rarely, tachycardia (fast heart rate). Therefore, in a patient prescribed a calcium channel blocker for hypertension, the nurse should closely monitor for any signs and symptoms of tachycardia as it can be a serious adverse effect that needs prompt evaluation and intervention to prevent complications.
A patient with chronic obstructive pulmonary disease (COPD) presents with acute exacerbation and severe dyspnea. Arterial blood gas (ABG) analysis reveals pH 7.28, PaO2 55 mmHg, PaCO2 65 mmHg, and HCO3- 30 mEq/L. Which of the following acid-base disturbances is most likely present in this patient?
- A. Respiratory acidosis with metabolic compensation
- B. Respiratory alkalosis with metabolic compensation
- C. Metabolic acidosis with respiratory compensation
- D. Metabolic alkalosis with respiratory compensation
Correct Answer: A
Rationale: In this case, the patient is experiencing respiratory acidosis as indicated by the low pH (7.28), elevated PaCO2 (65 mmHg), and elevated HCO3- (30 mEq/L). The primary acid-base disturbance is respiratory acidosis due to the retention of carbon dioxide (PaCO2 >45 mmHg) leading to an increase in HCO3- as a compensatory mechanism to maintain pH within normal limits. The elevated HCO3- levels (metabolic compensation) are trying to counterbalance the increased PaCO2 levels (respiratory acidosis) by increasing bicarbonate to attempt to normalize the pH. Overall, the ABG analysis shows respiratory acidosis with metabolic compensation in this COPD patient with an acute exacerbation and severe dyspnea.
A patient presents with chest pain at rest, unrelated to exertion, and not relieved by nitroglycerin. An electrocardiogram (ECG) shows ST-segment depression. Which cardiovascular disorder is most likely responsible for these symptoms?
- A. Stable angina
- B. Unstable angina
- C. Acute myocardial infarction
- D. Prinzmetal's angina
Correct Answer: B
Rationale: Unstable angina is characterized by chest pain at rest, which is not relieved by nitroglycerin. The ECG findings in unstable angina typically show ST-segment depression or T-wave inversion. It is considered a medical emergency as it can progress to a myocardial infarction. Stable angina, on the other hand, is chest pain or discomfort that occurs with exertion and is relieved by rest or medications like nitroglycerin. Acute myocardial infarction would typically present with ST-segment elevation on ECG, while Prinzmetal's angina is characterized by transient ST-segment elevation due to coronary artery vasospasm.
Which of the following is a common complication associated with prostatectomy for the treatment of benign prostatic hyperplasia (BPH)?
- A. Erectile dysfunction
- B. Urinary incontinence
- C. Retrograde ejaculation
- D. Urethral stricture
Correct Answer: B
Rationale: Urinary incontinence is a common complication associated with prostatectomy for the treatment of benign prostatic hyperplasia (BPH). Prostate surgery, such as a prostatectomy, can disrupt the sphincter muscle that controls the flow of urine from the bladder, leading to temporary or even long-term urinary incontinence in some patients. This usually improves over time with pelvic floor exercises and other treatment options, but it is an important consideration when discussing the potential risks and benefits of prostate surgery with patients. While erectile dysfunction and retrograde ejaculation can also be potential side effects of prostate surgery, urinary incontinence is specifically associated with issues related to bladder control following the procedure. Urethral stricture, although it can occur post prostate surgery, is less common compared to urinary incontinence.
A postpartum client who experienced a vaginal delivery expresses concerns about resuming sexual activity. What information should the nurse provide to address the client's concerns?
- A. Discuss the potential use of barrier contraceptives for contraception.
- B. Educate the client about the normal changes in sexual desire and response.
- C. Recommend delaying sexual activity until the postpartum check-up.
- D. Encourage the client to use lubricants to alleviate discomfort.
Correct Answer: B
Rationale: Option B is the most appropriate response when addressing a postpartum client's concerns about resuming sexual activity after a vaginal delivery. Educating the client about the normal changes in sexual desire and response following childbirth can help alleviate anxiety and provide reassurance. It is crucial for the nurse to explain that it is common for women to experience changes in libido, physical discomfort, and emotional adjustments after giving birth. By discussing these normal postpartum changes, the nurse can support the client in understanding that her feelings are valid and that it may take time for her to feel ready to engage in sexual activity again. Furthermore, the nurse can provide information on ways to enhance comfort and intimacy when resuming sexual activity, such as communication with partners, using lubricants, and gradually easing back into sexual activity as desired.