A nurse is performing tracheostomy care for a client and suctioning to remove copious secretions. Which of the following actions should the nurse take?

A. Divalproex: Divalproex is typically administered with food to minimize gastrointestinal side effects and enhance absorption. Administering it after breakfast or with a meal is recommended to reduce the risk of stomach upset and improve its bioavailability. Taking divalproex with food also helps to slow its absorption, which can decrease the incidence of adverse effects such as nausea and vomiting.
B. Mycostatin mouthwash: Mycostatin mouthwash is a topical antifungal medication used to treat oral candidiasis. Unlike systemic medications, its efficacy is not significantly influenced by food intake. Therefore, it can be administered before or after meals as prescribed, depending on the convenience of the patient. However, if the patient has oral lesions or discomfort, administering it after meals may be preferable to provide relief and ensure maximum contact time with affected areas.
C. Digoxin: Digoxin is a cardiac glycoside commonly used to treat heart failure and atrial fibrillation. It is typically administered on an empty stomach to facilitate optimal absorption. Giving digoxin before breakfast allows for consistent drug levels and reduces the risk of food interfering with its absorption. By administering it before meals, the nurse ensures that the medication is absorbed efficiently and its therapeutic effects are maximized.
D. Alendronate: Alendronate is a bisphosphonate medication used in the treatment of osteoporosis to prevent bone loss and reduce the risk of fractures. It requires administration on an empty stomach in the morning, usually at least 30 minutes before the first meal or beverage of the day, with a full glass of water. This timing ensures adequate absorption and minimizes the risk of esophageal irritation and ulceration. Alendronate has poor oral bioavailability, and taking it with food, beverages, or medications can significantly decrease its absorption. Therefore, administering it before breakfast on an empty stomach is crucial to optimize its effectiveness and reduce the potential for adverse gastrointestinal effects.

A. "I will be sure to take the albuterol before taking the cromolyn": Taking albuterol before cromolyn is the correct sequence because albuterol is a bronchodilator that helps open the airways quickly, while cromolyn is a mast cell stabilizer that helps prevent asthma symptoms. Taking albuterol first allows for better penetration of cromolyn into the airways. Therefore, this statement indicates an understanding of the appropriate sequence for using the medications.
B. "I will use both medications immediately after exercising": While it is essential to use albuterol before exercise to prevent exercise-induced bronchospasm, using cromolyn immediately after exercise is not typically indicated. Cromolyn is more effective when used prophylactically to prevent asthma attacks triggered by allergens or exercise rather than as an acute rescue medication.
C. "If my breathing begins to feel tight, I will use the cromolyn immediately": Cromolyn is not indicated for the immediate relief of acute bronchospasm. It works best when used regularly to prevent asthma symptoms rather than as a rescue medication during an asthma attack. Albuterol is the appropriate choice for immediate relief of tightness or wheezing.
D. "I will administer the medications 10 minutes apart": While it's important to space out the administration of different medications to ensure proper absorption and effectiveness, the specific timing between albuterol and cromolyn may vary based on individual instructions from the healthcare provider. Generally, it's recommended to take albuterol first, followed by cromolyn after a brief interval.