A nurse is preparing to administer diphenhydramine 25 mg PO every 6 hr. to an older adult client who has rhinitis. The amount available is diphenhydramine syrup 12.5 mg/5 mile How many ml should the nurse administer?
(Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

Choice A Reason:
Digoxin is a cardiac medication used to treat heart conditions such as heart failure and certain arrhythmias. There's no direct chemical relationship between digoxin and sulfa compounds. Generally, digoxin does not contain sulfa components, so it's less likely to cause an allergic reaction in individuals with sulfa allergies. This medication does not typically require clarification for someone with a sulfa allergy.

Choice B Reason:
Prednisone is a corticosteroid used to treat a variety of conditions, including inflammation, allergies, and autoimmune disorders. It does not contain sulfonamide groups in its structure. As a corticosteroid, prednisone is distinct from sulfonamide drugs and is generally considered safe for individuals with sulfa allergies. There is typically no need to clarify this medication for a sulfa-allergic client.

Choice C Reason:
Celecoxib is a nonsteroidal anti-inflammatory drug (NSAID) that belongs to the sulfonamide class. While it is not the same as sulfonamide antibiotics, it contains a sulfonamide moiety in its chemical structure. There's a possibility of cross-reactivity or allergic reactions in individuals with sulfa allergies due to the structural similarity, making it essential to clarify this prescription for someone with a sulfa allergy.

Choice D Reason:
Atorvastatin is a statin medication used to lower cholesterol levels. It does not contain a sulfonamide group in its structure. Statins belong to a different drug class and do not typically pose a risk of cross-reactivity in individuals with sulfa allergies. Therefore, atorvastatin is generally considered safe and does not usually require clarification for a sulfa-allergic client.

Choice A Reason:
Refill the prescription every 12 months. This statement focuses on the frequency of prescription refills rather than guidance on the medication's use. While it's important to keep prescriptions up to date, this instruction doesn't directly relate to the administration or use of sublingual nitroglycerin for angina.
Choice B Reason:
Take a second tablet after 5 minutes for unrelieved chest pain. This advice is crucial because if the chest pain persists after the first tablet, taking a second tablet after 5 minutes (and seeking emergency medical assistance if pain persists after the second tablet) is part of the recommended protocol for managing unstable angina with sublingual nitroglycerin.
Choice C Reason:
Swallow the tablet whole with a glass of water. Sublingual nitroglycerin is designed to dissolve under the tongue, not to be swallowed. The medicine is absorbed through the blood vessels in the mouth to provide rapid relief for angina symptoms. Instructing the patient to swallow the tablet defeats the purpose of sublingual administration.
Choice D Reason:
Store the medication in the refrigerator. Nitroglycerin should generally be stored in a cool, dry place and away from direct sunlight, but refrigeration is not necessary. Storing it in the refrigerator might actually alter the medication's effectiveness or consistency, making it less reliable for quick absorption when needed during an angina episode.