A nurse is caring for a client who has a prescription for clopidogrel.
Which of the following actions should the nurse plan to take?

Choice A rationale:

The nurse should include the statement, "Lifelong treatment with this medication is necessary.”. This is because rifampin is often part of a multidrug regimen used to treat tuberculosis, and treatment typically lasts for several months, sometimes up to a year. It is crucial for the client to understand the need for long-term treatment to ensure the successful eradication of the tuberculosis bacteria from their system.

Choice B rationale:

The statement, "The medication causes amenorrhea if taken along with an oral contraceptive," is not accurate. Rifampin is known to interact with oral contraceptives, decreasing their effectiveness, but it does not directly cause amenorrhea. The correct teaching should focus on the need for alternative or additional contraceptive methods while taking rifampin.

Choice C rationale:

The statement, "You should wear glasses instead of contacts while taking this medication," is not directly related to rifampin. Rifampin can cause certain ocular side effects, but it does not necessarily require the client to switch from contacts to glasses. This advice would depend on the individual's eye health and any specific concerns.

Choice D rationale:

The statement, "A yellow tint to the skin is an expected reaction to the medication," is incorrect. While rifampin can cause a harmless side effect of orange-red discoloration of body fluids, such as urine, sweat, and tears, it does not typically cause a yellow tint to the skin. The nurse should clarify this misconception with the client.

The correct answer is Choice D: Headache.

Rationale for Choice D (Headache): Hyponatremia, defined as a serum sodium level below 135 mEq/L, can lead to various neurological symptoms due to the altered osmotic pressure in the brain cells. When the sodium level drops below normal, water moves into the cells, causing them to swell, which can lead to increased intracranial pressure and subsequent headaches. Therefore, a client with a sodium level of 128 mEq/L is likely to experience headaches as a manifestation of hyponatremia.

Rationale for other choices:

Choice A: Hyporeflexia Hyporeflexia refers to diminished or absent reflexes. While hyponatremia can affect neurological function, hyporeflexia is not a typical manifestation. Instead, hyperreflexia may occur in severe cases due to cerebral edema and increased intracranial pressure.

Choice B: Constipation Constipation is not a common manifestation of hyponatremia. Gastrointestinal symptoms such as nausea, vomiting, and abdominal cramping may occur, but constipation is not typically associated with sodium imbalances.

Choice C: Increased appetite Hyponatremia does not typically cause increased appetite. Instead, gastrointestinal symptoms such as nausea and anorexia are more commonly observed. Increased appetite is not directly related to sodium levels but may be seen in conditions such as hyperthyroidism or certain medications.

Therefore, based on the provided data and typical manifestations of hyponatremia, the correct answer is Choice D: Headache. This is because headaches are a common neurological symptom associated with low sodium levels and increased intracranial pressure.