A client with rheumatoid arthritis and psoriasis has been prescribed adalimumab, a biologic agent that blocks tumor necrosis factor alpha (TNF-alpha). Which of the following statements by the client indicates a need for further teaching?

Choice A reason: This is not a statement that indicates a need for further teaching. The client should avoid alcohol and other substances that can harm the liver, as adalimumab can increase the risk of liver toxicity and hepatitis.

Choice B reason: This is a statement that indicates a need for further teaching. The client should not take naproxen and aspirin as needed for pain relief, as these are nonsteroidal anti-inflammatory drugs (NSAIDs) that can increase the risk of bleeding and gastrointestinal ulcers. Adalimumab can also increase the risk of bleeding and ulcers, as it suppresses the immune system and the inflammatory response.

Choice C reason: This is not a statement that indicates a need for further teaching. The client should report any signs of infection or fever to the doctor, as adalimumab can increase the risk of serious infections and sepsis. Adalimumab can also mask the symptoms of infection, such as inflammation and pain.

Choice D reason: This is not a statement that indicates a need for further teaching. The client should inject the medication under the skin of the abdomen or thigh, as this is the recommended route and site for adalimumab administration.

Choice A reason: Constipation is not a priority finding for a client with peptic ulcer disease. It may be a side effect of some medications or a result of decreased fluid intake, but it does not indicate a serious complication.

Choice B reason: Dyspepsia is a common symptom of peptic ulcer disease, but it is not a priority finding. It refers to indigestion or discomfort in the upper abdomen, which may be relieved by antacids or other medications.

Choice C reason: Hematemesis is a priority finding for a client with peptic ulcer disease. It indicates bleeding from the ulcer, which can lead to shock and anemia. The nurse should monitor the client's vital signs, hemoglobin level, and blood loss, and notify the provider immediately.

Choice D reason: Epigastric discomfort is another common symptom of peptic ulcer disease, but it is not a priority finding. It refers to pain or burning in the upper abdomen, which may be worsened by food intake or stress. The nurse should provide comfort measures and educate the client on dietary and lifestyle modifications.