A nurse is caring for a client who has asthma and allergies. The client asks the nurse about environmental influences they should avoid. The nurse should inform the client to avoid which of the following?

Choice A reason: Administering the medication 2 hr before exercise is a correct instruction for the parent of a child who has asthma and a prescription for montelukast granules. Montelukast is a leukotriene modifier that helps to prevent asthma attacks and exercise induced bronchoconstriction. It is taken once a day in oral form and may cause side effects such as stomach pain, diarrhea, or mood changes. For children who have exercise induced asthma, an additional dose of montelukast may be taken 2 hr before exercise.

Choice B reason: Giving the medication at the onset of wheezing is not a correct instruction for the parent of a child who has asthma and a prescription for montelukast granules. Montelukast is not a fast acting rescue medicine for asthma attacks and needs to be taken daily. It does not work quickly enough to relieve the symptoms of an acute asthma attack, such as wheezing, coughing, or shortness of breath. For an asthma attack, the child should use a short acting beta agonist inhaler, such as albuterol, as prescribed by the provider.

Choice C reason: Administering the granules mixed with 20 oz of water is not a correct instruction for the parent of a child who has asthma and a prescription for montelukast granules. Montelukast granules come in a sachet with 4 mg of granules inside (one dose). They can be placed directly on the child's tongue or mixed with a spoonful of cold or room temperature soft food, such as applesauce, mashed carrots, rice, or ice cream. They can also be mixed with 1 teaspoonful (5 mL) of cold or room temperature baby formula or breast milk. They should not be mixed with any other liquid drink other than baby formula or breast milk. The mixture should be taken within 15 minutes after opening the packet.

Choice D reason: Giving the medication in the morning daily is not a correct instruction for the parent of a child who has asthma and a prescription for montelukast granules. Montelukast works best when taken in the evening, as it can improve the symptoms of asthma and allergic rhinitis that occur at night or early in the morning. Taking it at the same time every day can also help to maintain a steady level of the drug in the body and prevent missed doses.

Choice A reason: Encourage the use of wide grip utensils. This action is not related to homonymous hemianopsia, but to the motor weakness or paralysis that may occur on the opposite side of the body after a stroke. Wide grip utensils can help the client hold and use them more easily.

Choice B reason: Remind the client to look for food on the left side of the tray. This action is appropriate because homonymous hemianopsia is a visual field loss on the same side of both eyes. A client who had a right sided stroke will have difficulty seeing the left side of their visual field. Reminding the client to look for food on the left side of the tray will help them eat more completely and prevent malnutrition.

Choice C reason: Provide a nonskid mat to alleviate plate movement. This action is not related to homonymous hemianopsia, but to the safety and stability of the client's eating environment. A nonskid mat can prevent the plate from sliding or falling off the tray.

Choice D reason: Encourage the client to use his right hand when feeding himself. This action is not related to homonymous hemianopsia, but to the motor weakness or paralysis that may occur on the opposite side of the body after a stroke. Encouraging the client to use his right hand can help him maintain his independence and function.