Choice A reason: Hard candy can be used for a dry mouth, which is a common side effect of St. John's wort.

Choice B reason: Another form of contraception is needed, because St. John's wort can reduce the effectiveness of oral contraceptives and increase the risk of unplanned pregnancy. This information requires further instruction from the nurse.

Choice C reason: Insomnia may occur while taking the medication, which is another possible side effect of St. John's wort. The client should be advised to take the medication in the morning or afternoon, and avoid caffeine and alcohol.

Choice D reason: Sensitivity to the sun can develop, which is a rare but serious side effect of St. John's wort. The client should be instructed to wear sunscreen and protective clothing when exposed to sunlight.

Choice A reason: Cheese and crackers are not a good snack to take with tetracycline, because cheese contains calcium, which can interfere with the absorption of tetracycline and reduce its effectiveness.

Choice B reason: Toasted wheat bread and jelly are a suitable snack to take with tetracycline, because they do not contain any dairy products or iron, which can also affect the absorption of tetracycline. Toasted bread may also help to settle the stomach and prevent nausea.

Choice C reason: Fruit-flavored yogurt is not a good snack to take with tetracycline, because yogurt is a dairy product that contains calcium, which can interfere with the absorption of tetracycline and reduce its effectiveness.

Choice D reason: Cold cereal with skim milk is not a good snack to take with tetracycline, because skim milk is a dairy product that contains calcium, which can interfere with the absorption of tetracycline and reduce its effectiveness.

Choice A reason: Platelet count of 100,000/mm³ (100 x 10^9/L) is below the normal range and indicates thrombocytopenia, which is a decrease in the number of platelets in the blood. Thrombocytopenia can increase the risk of bleeding and bruising, and can be a serious adverse effect of enoxaparin. This laboratory result requires immediate action by the nurse, such as notifying the prescriber, monitoring for signs of bleeding, and withholding the next dose of enoxaparin.

Choice B reason: Hematocrit 45% (0.45 volume fraction) is within the normal range and does not indicate any problem with the client's red blood cells or oxygen-carrying capacity.

Choice C reason: Blood urea nitrogen (BUN) 20 mg/dL (7.1 mmol/L) is within the normal range and does not indicate any problem with the client's kidney function or hydration status.

Choice D reason: Serum creatinine 1.0 mg/dL (88.4 μmol/L) is within the normal range and does not indicate any problem with the client's kidney function or muscle metabolism.

Choice A reason: Increased anxiety and nervousness have been reported by some people taking feverfew, but this is not a common or serious side effect. It may be related to individual sensitivity or dosage.

Choice B reason: Feverfew may interact with aspirin or non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, which are commonly used for pain relief. Feverfew and these drugs can both inhibit platelet aggregation and increase the risk of bleeding. This information is most important for the nurse to include in a teaching plan for this client, especially if they are taking any of these medications or have a history of bleeding disorders.

Choice C reason: Those with allergies to chamomile, ragweed, or yarrow should not take feverfew, because they may have a cross-reactivity and experience an allergic reaction to feverfew. This information is important for the nurse to include in a teaching plan for this client, but it is not as critical as choice B.

Choice D reason: Abdominal pain, gas, nausea, vomiting, and diarrhea can occur when taking feverfew, but these are usually mild and transient side effects that do not require medical attention. They may be reduced by taking feverfew with food or water.

Choice A reason: Depression screening is not directly related to the effectiveness of orlistat, which is a medication that blocks the absorption of fat from the diet and helps to reduce weight. Depression screening may be important for the overall mental health of the client, but it is not an ongoing assessment for orlistat.

Choice B reason: Body mass index (BMI) is a measure of body fat based on height and weight, and it is used to assess the risk of obesity-related health problems. BMI is an ongoing assessment for orlistat, because it can indicate the progress and outcome of the weight management program. The goal of orlistat therapy is to achieve and maintain a healthy BMI.

Choice C reason: Daily calorie count is not an ongoing assessment for orlistat, because it does not reflect the amount of fat absorbed by the body. Orlistat works by blocking the action of lipase, an enzyme that breaks down fat in the intestine. Therefore, even if the client consumes a high-calorie diet, orlistat can prevent some of the fat from being absorbed and reduce weight. However, daily calorie count may be useful for monitoring the overall nutritional intake and energy balance of the client.

Choice D reason: Serum protein levels are not an ongoing assessment for orlistat, because they are not affected by the medication. Orlistat only blocks the absorption of fat, not protein or carbohydrates. Serum protein levels may be important for evaluating the nutritional status and organ function of the client, but they are not an indicator of orlistat effectiveness.

Choice A reason: Beef tips with gravy are not a dietary choice that should be avoided by a client taking phenelzine, which is a monoamine oxidase inhibitor (MAOI) that treats depression. Beef tips with gravy do not contain tyramine, which is a substance that can interact with MAOIs and cause a hypertensive crisis.

Choice B reason: Deep-fried shrimp are not a dietary choice that should be avoided by a client taking phenelzine, which is a monoamine oxidase inhibitor (MAOI) that treats depression. Deep-fried shrimp do not contain tyramine, which is a substance that can interact with MAOIs and cause a hypertensive crisis.

Choice C reason: Pepperoni pizza is a dietary choice that should be avoided by a client taking phenelzine, which is a monoamine oxidase inhibitor (MAOI) that treats depression. Pepperoni pizza contains tyramine, which is a substance that can interact with MAOIs and cause a hypertensive crisis. Tyramine is found in aged, fermented, cured, smoked, or pickled foods, such as cheese, salami, sauerkraut, soy sauce, beer, and wine.

Choice D reason: Pan-seared catfish is not a dietary choice that should be avoided by a client taking phenelzine, which is a monoamine oxidase inhibitor (MAOI) that treats depression. Pan-seared catfish does not contain tyramine, which is a substance that can interact with MAOIs and cause a hypertensive crisis.

Choice A reason: Apical pulse rate of 50 beats/minute requires nursing intervention prior to the administration of digoxin, which is a medication that slows down and strengthens the heartbeat. Digoxin can cause bradycardia, which is a slow heart rate below 60 beats/minute. Bradycardia can lead to inadequate blood flow and oxygen delivery to the body. The nurse should withhold the dose of digoxin and notify the prescriber if the apical pulse rate is below 60 beats/minute.

Choice B reason: Irregular apical pulse rhythm does not require nursing intervention prior to the administration of digoxin, which is a medication that treats arrhythmias, which are irregular heart rhythms. Digoxin can correct or prevent some types of arrhythmias, such as atrial fibrillation or flutter. The nurse should monitor the apical pulse rhythm and report any changes to the prescriber, but it is not a reason to withhold the dose of digoxin.

Choice C reason: Presence of a systolic heart murmur does not require nursing intervention prior to the administration of digoxin, which is a medication that improves the pumping function of the heart. A systolic heart murmur is a sound that occurs when the heart contracts and blood flows through a narrow or leaky valve. Digoxin can reduce the symptoms of heart failure, such as shortness of breath, fatigue, and edema, which may be associated with a systolic heart murmur. The nurse should document the presence and characteristics of the heart murmur, but it is not a reason to withhold the dose of digoxin.

Choice D reason: Apical pulse heard best at the pulmonic site does not require nursing intervention prior to the administration of digoxin, which is a medication that affects the electrical activity and contractility of the heart. The apical pulse is the heartbeat heard at the apex of the heart, which is located at the fifth intercostal space on the left midclavicular line. The pulmonic site is located at the second intercostal space on the left sternal border, where the sound of blood flow through the pulmonary valve can be heard. The nurse should listen to the apical pulse at the correct location, but it is not a reason to withhold the dose of digoxin.

Choice A reason: Increasing intake of fluids and high protein foods is not an instruction that the nurse should provide to the client who is taking baclofen, which is a medication that relaxes skeletal muscles and reduces spasticity. Fluids and high protein foods do not affect the action or side effects of baclofen.

Choice B reason: Stopping taking the medication immediately is not an instruction that the nurse should provide to the client who is taking baclofen, which is a medication that should be tapered off gradually under medical supervision. Abrupt withdrawal of baclofen can cause serious complications, such as seizures, hallucinations, and increased spasticity.

Choice C reason: Obtaining transportation to the emergency department is not an instruction that the nurse should provide to the client who is taking baclofen, which is a medication that can cause mild and transient side effects, such as fatigue and dizziness. These side effects are not life-threatening and usually subside as the body adjusts to the medication.

Choice D reason: Avoiding hazardous activities until symptoms subside is an instruction that the nurse should provide to the client who is taking baclofen, which is a medication that can impair the ability to drive, operate machinery, or perform other tasks that require alertness and coordination. The client should be advised to exercise caution and avoid activities that could result in injury until they are no longer experiencing fatigue and dizziness.

Choice A reason: Expectorating bronchial secretions is not an assessment information that indicates that the antitussive medication benzonatate is effective. Benzonatate is a medication that suppresses the cough reflex by numbing the throat and lungs. It does not loosen or thin the mucus in the airways, which would facilitate expectoration.

Choice B reason: Reports reduced nasal discharge is not an assessment information that indicates that the antitussive medication benzonatate is effective. Benzonatate is a medication that suppresses the cough reflex by numbing the throat and lungs. It does not affect the production or drainage of nasal secretions, which are caused by inflammation and infection in the upper respiratory tract.

Choice C reason: Able to sleep through the night is not an assessment information that indicates that the antitussive medication benzonatate is effective. Benzonatate is a medication that suppresses the cough reflex by numbing the throat and lungs. It does not have any sedative or hypnotic effects, which would promote sleep. However, by reducing coughing, benzonatate may indirectly improve the quality of sleep for the client.

Choice D reason: Denies having coughing spells is an assessment information that indicates that the antitussive medication benzonatate is effective. Benzonatate is a medication that suppresses the cough reflex by numbing the throat and lungs. It reduces the frequency and intensity of coughing, which can relieve discomfort and irritation for the client.

Choice A reason: Eliminating use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, is an instruction that the nurse should provide to the client who is taking lithium carbonate, which is a medication that stabilizes mood and prevents manic episodes. NSAIDs can increase the blood levels of lithium and cause toxicity, which can manifest as nausea, vomiting, tremors, confusion, or seizures.

Choice B reason: Monitoring blood glucose levels daily is not an instruction that the nurse should provide to the client who is taking lithium carbonate, which is a medication that does not affect the blood sugar levels or the risk of diabetes. Blood glucose levels may be important for the general health of the client, but they are not related to lithium therapy.

Choice C reason: Notifying healthcare provider prior to dental procedures is not an instruction that the nurse should provide to the client who is taking lithium carbonate, which is a medication that does not interact with local anesthetics or antibiotics that may be used during dental procedures. However, the client should inform the dentist about their medical history and medications, as a precaution.

Choice D reason: Avoiding consuming all foods that contain iodine is not an instruction that the nurse should provide to the client who is taking lithium carbonate, which is a medication that does not interfere with the thyroid function or the metabolism of iodine. Iodine is an essential nutrient that is found in many foods, such as seafood, dairy products, eggs, and iodized salt. Avoiding iodine can cause deficiency and lead to goiter or hypothyroidism.