A patient with type 2 diabetes and heart failure who is prescribed metformin extended release (Glucophage XR) once daily now has muscle aches, drowsiness, low blood pressure, and a slow irregular heartbeat. What is the nurse's best action?
a. Assess the patient's blood glucose level and prepare to administer intravenous (IV) glucose.
b. Assess the patient's blood glucose level and prepare to administer insulin.
c. Hold the dose and notify the prescriber immediately.
d. Administer the drug at bedtime to prevent falls.
C
The muscle aches, drowsiness, low blood pressure, and a slow irregular heartbeat are symptoms of lactic acidosis, an adverse reaction to metformin. The drug should be stopped and the prescriber notified so that steps can be taken to reduce the acidosis.
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