Medical Surgical Myocardial Infarction #8

Question

The nurse is scheduling a client for a cardiac catheterization. The client has type 2 diabetes and takes metformin. Which action will the nurse take prior to scheduling the procedure?

Answers

  1. The nurse will instruct the client to have a fasting A1C and glucose tolerance test prior to the procedure.
    • Rationale:

      This answer is not correct because instructing the client to have a fasting A1C and glucose tolerance test prior to the procedure is not necessary nor the priority. The nurse should teach the client to hold the metformin for 24 hours before the procedure and 48 hours after any procedure. This is due to the risk of lactic acidosis associated with the combination of anesthesia and/or contrast medium with metformin.

  2. The nurse will instruct the client to eat a low carbohydrate diet three days prior to the procedure.
    • Rationale:

      This answer is not correct because although eating a low-carbohydrate, 1800-calorie American Diabetic Association diet is always important for a diabetic, the most important action for the nurse to take is teaching how to take metformin. The nurse should teach the client to hold the metformin for 24 hours before the procedure and 48 hours after any procedure due to the risk of lactic acidosis associated with the anesthesia and/or contrast medium.

  3. The nurse will instruct the client to hold the metformin for 24 hours before the procedure and 48 hours after the procedure.
    • Rationale:

      This answer is correct because the nurse should teach the client prior to the procedure to hold the metformin for 24 hours before the procedure and 48 hours after any procedure. This is due to the risk of lactic acidosis associated with the combination of anesthesia and/or contrast medium with metformin. The contrast medium may affect kidney function, and metformin in the system may increase risk of lactic acidosis. Holding the drug 24 hours prior and 48 hours following the procedure will minimize complications.

  4. The nurse instructs the client to take all medications the morning of the procedure but not to drink or eat afterwards.
    • Rationale:

      This answer is not correct because the client should be taught to hold the metformin for 24 hours before the procedure and 48 hours after any procedure. This is due to the risk of lactic acidosis associated with the combination of anesthesia and/or contrast medium with metformin.

Overview

Metformin is an oral antidiabetic medication. The nurse will instruct the client to hold the metformin for 24 hours before the procedure and 48 hours after the procedure.

Explanation

Learning Outcomes

Metformin is an oral antidiabetic medication used for treatment of diabetes mellitus type 2, when lifestyle changes and weight loss has not adequately lowered the blood glucose. The nurse should teach the client to hold the metformin for 24 hours before the procedure and 48 hours after any procedure. This is due to the risk of lactic acidosis associated with the combination of anesthesia and/or contrast medium with metformin. The contrast medium may affect kidney function, and metformin in the system may increase risk of lactic acidosis. Holding the drug 24 hours prior and 48 hours following the procedure will minimize complications.

Test Taking Tip

Most home medications are continued immediately following procedures or surgeries. Metformin is one of the rare medications held for 48 hours after procedures to reduce the complication of lactic acidosis. Remember the rare, unusual exceptions to the rule about medications.

Video Rationale