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) Take albuterol first.
Taking albuterol before salmeterol does not address the potential interaction between the two medications. It is important to avoid taking them together rather than just adjusting the order of administration.

B) The order of administration does not matter.
The order of administration does matter when it comes to medications with potential interactions. In this case, both albuterol and salmeterol are bronchodilators, and taking them together can increase the risk of adverse effects.

C) Take salmeterol first.
Similar to taking albuterol first, taking salmeterol before albuterol does not address the potential interaction between the two medications. The priority is to avoid taking them together unless specifically directed by the healthcare provider.

D) They should not be taken together.
Albuterol and salmeterol are both bronchodilators used to treat respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD). Albuterol is a short-acting beta agonist (SABA), typically used for quick relief of acute bronchoconstriction, while salmeterol is a long-acting beta agonist (LABA), used for long-term control and prevention of bronchospasm. Taking both medications together can increase the risk of side effects, including excessive stimulation of the beta receptors and potential cardiovascular effects. Therefore, it is important to follow healthcare provider's instructions and avoid taking albuterol and salmeterol together unless specifically directed to do so.

A. Decreased cardiac output: Inotropic medications are intended to improve cardiac function and increase cardiac output, so monitoring for signs of decreased cardiac output would be contrary to the expected therapeutic effect of these medications.

B. Increased afterload: Inotropic medications primarily affect the contractility of the heart muscle and do not typically have a direct effect on afterload (the force against which the heart must pump blood). While changes in afterload can occur as a secondary consequence of altered cardiac function, monitoring for signs of increased afterload would not be the primary focus after administering an inotropic medication.

C. Increased cardiac output.
Inotropic medications are drugs that affect the contractility of the heart muscle. They are often used in the management of shock to improve cardiac function and increase cardiac output. Therefore, after administering an inotropic medication, the nurse would monitor the patient for signs of increased cardiac output, such as improved peripheral perfusion, increased blood pressure, and resolution of signs and symptoms of shock.

D. Slowing of the heart rate: Inotropic medications can affect heart rate indirectly by altering cardiac output, but their primary effect is on contractility rather than heart rate. Monitoring for signs of bradycardia (slowing of the heart rate) may be appropriate in certain clinical situations, but it is not the primary consideration after administering an inotropic medication for shock.