A client with peptic ulcer disease receives a new prescription for cimetidine. Which statement provided by the client requires additional instruction by the nurse?

Choice A reason: This is the correct action for the nurse to take. Risedronate is a bisphosphonate that is used to treat osteoporosis by inhibiting bone resorption. It should be taken with a full glass of water at least 30 minutes before the first food or drink of the day, as food and beverages can reduce its absorption and effectiveness. Milk and other dairy products are especially problematic, as they contain calcium, which can bind to risedronate and prevent it from reaching the bone.

Choice B reason: This is not a correct action for the nurse to take. Assigning a UAP to bring the client a glass of low fat milk is not appropriate, as it contradicts the instruction to take risedronate with water only. Low fat milk still contains calcium, which can interfere with risedronate absorption. The nurse should educate the client and the UAP about the proper administration of risedronate and the importance of avoiding food and beverages for at least 30 minutes after taking the medication.

Choice C reason: This is not a correct action for the nurse to take. Consulting with a pharmacist about scheduling the dose one hour after the client eats is not necessary, as risedronate should be taken before the first food or drink of the day, not after. Taking risedronate one hour after eating may not ensure adequate absorption and efficacy, as food and beverages can remain in the stomach for longer periods of time. The nurse should follow the prescribed schedule and the manufacturer's guidelines for risedronate administration.

Choice D reason: This is not a correct action for the nurse to take. Withholding the medication until the client's breakfast tray is available on the unit is not advisable, as it may delay the treatment of osteoporosis and increase the risk of fractures. Risedronate should be taken as soon as possible after waking up, before the first food or drink of the day, to maximize its absorption and effectiveness. The nurse should not postpone the medication administration without consulting the healthcare provider.

Choice A reason: This is not an appropriate instruction for the nurse to include in the client's plan of care. Replacing salt with a salt substitute is not recommended for clients taking spironolactone, as most salt substitutes contain potassium. Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia, or high levels of potassium in the blood. The client should avoid salt substitutes and other sources of potassium.

Choice B reason: This is not an appropriate instruction for the nurse to include in the client's plan of care. Monitoring skin for excessive bruising is not related to the use of spironolactone, as it does not affect the blood clotting process. The client should monitor for signs of bleeding, such as nosebleeds, gum bleeding, or blood in the urine or stool, if he or she is taking other medications that can interfere with clotting, such as aspirin or warfarin.

Choice C reason: This is not an appropriate instruction for the nurse to include in the client's plan of care. Covering the skin before going outside is not necessary for clients taking spironolactone, as it does not cause photosensitivity or increased risk of sunburn. The client should protect the skin from sun exposure as part of general health promotion, but it is not specific to spironolactone therapy.

Choice D reason: This is the appropriate instruction for the nurse to include in the client's plan of care. Limiting intake of high-potassium foods is important for clients taking spironolactone, as it can prevent hyperkalemia and its complications, such as cardiac arrhythmias, muscle weakness, or paralysis. The client should avoid foods that are rich in potassium, such as bananas, oranges, tomatoes, potatoes, spinach, and dairy products. The client should also have regular blood tests to monitor the potassium levels.