A nurse is providing teaching to a client who reports smoking 3 packs of cigarettes per day and has a prescription for nicotine gum. Which of the following instructions should the nurse include in the teaching?

A. Hypotension: Hypotension can occur as an adverse effect of fentanyl, particularly if the client experiences excessive sedation or respiratory depression. Fentanyl is a potent opioid analgesic
that can cause vasodilation and a decrease in blood pressure, especially when used in high doses or in susceptible individuals.
B. Tachycardia: Tachycardia is not a typical adverse effect of fentanyl. Opioids like fentanyl typically cause bradycardia or have minimal effects on heart rate.
C. Diarrhea: Diarrhea is not a common adverse effect of fentanyl. Opioids more commonly cause constipation due to their effects on gastrointestinal motility.

D. Insomnia: Insomnia is not a typical adverse effect of fentanyl. Opioids typically cause sedation and can lead to drowsiness or somnolence, especially during initial use or when administered in high doses.

A. 0.45% sodium chloride: 0.45% sodium chloride solution, also known as half-normal saline, is a hypotonic solution used for rehydration and maintenance fluid therapy. However, in cases of
major burns where there is a significant loss of fluid and electrolytes, isotonic solutions are generally preferred.
B. Lactated Ringer's: Lactated Ringer's solution is an isotonic crystalloid solution that closely resembles the electrolyte composition of extracellular fluid. It is commonly used for fluid resuscitation in clients with major burns to replace lost fluids and electrolytes and restore
intravascular volume.

C. Dextrose 5% in water: Dextrose 5% in water is a hypotonic solution used primarily for hydration in clients with normal electrolyte levels or as a vehicle for administering medications.
It is not typically used for fluid resuscitation in clients with major burns, as it does not adequately replace lost electrolytes.
D. Dextrose 5% in 0.45% sodium chloride: This solution combines dextrose 5% and 0.45% sodium chloride and is used for maintenance fluid therapy and mild dehydration. However, in cases of major burns where there is significant fluid and electrolyte loss, isotonic solutions like lactated Ringer's or normal saline are preferred for fluid resuscitation.