A nurse is providing discharge dietary teaching to a client who has a new prescription for theophylline. Which of the following instructions should the nurse include?

Choice A Reason:
Tinnitus, a perception of noise or ringing in the ears, is not typically associated with paroxetine use.
Choice B Reason:
Drowsiness or somnolence is a common adverse effect associated with paroxetine and many other selective serotonin reuptake inhibitors (SSRIs). It's crucial for clients to be aware of this potential side effect, especially when starting the medication or adjusting the dosage. It might affect their ability to perform tasks requiring alertness, such as driving or operating machinery.
Choice C Reason:
Peripheral edema, or swelling in the extremities, is not a common adverse effect linked specifically to paroxetine use.
Choice D Reason:
Alopecia is correct. Alopecia, or hair loss, is not a commonly reported adverse effect of paroxetine.

Choice A Reason:
. "I will check the client's INR before administering the heparin." Is incorrect. Checking the client's INR (International Normalized Ratio) is essential, but it's more applicable for monitoring anticoagulants like warfarin, not heparin. Heparin's effect is typically monitored via activated partial thromboplastin time (aPTT) or anti-Xa levels, not INR.
Choice B Reason:
"I will aspirate before administering the heparin." Is incorrect. Aspirating before administering heparin injections is not necessary because the medication is given subcutaneously or intravenously and not into a blood vessel.
Choice C Reason:
"I will massage the site after injecting the heparin." Is incorrect. Massaging the site after injecting heparin could increase the risk of bruising or hematoma formation at the injection site. It's generally advised to avoid massaging the area after a heparin injection to prevent tissue trauma.
Choice D Reason:
"I will apply pressure for 1 minute after the injection." Is correct. Applying pressure to the injection site for about a minute after administering heparin helps minimize the risk of bleeding or hematoma formation, especially with subcutaneous injections. This practice aids in reducing bleeding at the injection site.