A nurse is assisting with the care of four clients who have peptic ulcer disease. The nurse should identify that misoprostol (Cytotec) is contraindicated for which of the following clients?

A. Hypotension: Norepinephrine is administered to treat hypotension, so monitoring for hypotension is not typically a concern while the patient is receiving this medication. In fact, hypotension is often the reason for administering norepinephrine in the first place.

B. Liver failure: Monitoring for signs of liver failure may be important in patients receiving certain medications, but it is not a specific consideration when administering norepinephrine. Norepinephrine primarily affects blood pressure regulation and does not typically have direct effects on liver function.

C. Bradycardia: While norepinephrine can increase blood pressure by constricting blood vessels, it may also cause reflex bradycardia (a decrease in heart rate) as a compensatory response. However, the primary concern with norepinephrine administration is hypertension, not bradycardia.

D. Hypertension
Norepinephrine (Levophed) is a vasopressor medication commonly used to treat hypotension and shock. It works by constricting blood vessels, which increases blood pressure. Therefore, when administering norepinephrine, the nurse should monitor the patient for hypertension, as the medication's intended effect is to raise blood pressure.

A) Take as needed for pain relief.
Sucralfate is not used as an as-needed medication for pain relief. It is a gastroprotective medication that is typically taken regularly as prescribed, regardless of whether the client is experiencing pain.

B) Take the medication 1 hr before meals.
Sucralfate is a medication commonly used to treat peptic ulcer disease by forming a protective barrier over the ulcer, promoting healing and symptom relief. It should be taken on an empty stomach, at least 1 hour before meals, and at bedtime to maximize its effectiveness. Taking sucralfate before meals ensures that the medication can coat the ulcer and provide protection against gastric acid during digestion.

C) Store the medication in the refrigerator.
Sucralfate does not need to be stored in the refrigerator. It should be stored at room temperature away from moisture and heat, according to the manufacturer's instructions.

D) Take the medication with an antacid.
Sucralfate should not be taken with antacids because antacids can interfere with its effectiveness. Antacids can decrease the absorption of sucralfate, so it is important to separate the administration of sucralfate from antacids by at least 30 minutes to 1 hour.