A client who is taking an oral contraceptive receives a new prescription for erythromycin. Which instruction should the nurse provide to the client?

Choice A reason: This is the correct action to include in the client's plan of care, as sucralfate should be given on an empty stomach, at least one hour before meals and at bedtime. Sucralfate is a mucosal protectant that forms a protective barrier over the ulcer and prevents further damage from acid and pepsin. It requires an acidic environment to work, so it should not be taken with food or antacids.

Choice B reason: This is not a relevant action to include in the client's plan of care, as sucralfate does not cause or increase the risk of secondary Candida infection. Candida infection is a fungal infection that can affect the mouth, throat, esophagus, or vagina. It is more common in clients who use antibiotics, corticosteroids, or immunosuppressants, but not sucralfate.

Choice C reason: This is not an accurate action to include in the client's plan of care, as sucralfate should be administered four times a day, not once a day. Sucralfate has a short duration of action, so it needs to be taken frequently to maintain its protective effect on the ulcer.

Choice D reason: This is not a necessary action to include in the client's plan of care, as sucralfate does not cause or affect electrolyte imbalance. Electrolyte imbalance is an abnormality in the levels of sodium, potassium, calcium, magnesium, or other minerals in the blood. It can be caused by dehydration, vomiting, diarrhea, kidney disease, or other conditions, but not sucralfate.

Choice A reason: Diarrhea is a common side effect of metoclopramide, but it is not life-threatening or indicative of a serious reaction. The nurse should monitor the client's fluid and electrolyte status and provide supportive care.

Choice B reason: Involuntary movements, such as twitching, grimacing, or spasms, are signs of a rare but serious condition called tardive dyskinesia, which can be caused by metoclopramide. This condition can be irreversible and disabling, so the nurse should report it immediately and stop the medication.

Choice C reason: Nausea is the reason why the client is receiving metoclopramide, which is an antiemetic drug. If the client still experiences nausea, the nurse should assess the effectiveness of the medication and notify the prescriber if needed.

Choice D reason: Unusual irritability is not a common or serious side effect of metoclopramide. It may be related to other factors, such as stress, pain, or fatigue. The nurse should provide emotional support and reassurance to the client.