A nurse is reviewing the chart of a client who has a prescription for eptifibatide. The nurse should identify which of the following medications as a contraindication for this medication?

Choice A reason: Consuming additional calories each day is essential to support milk production. Breastfeeding mothers require approximately 450–500 extra calories daily to meet the increased metabolic demands of lactation. Adequate nutrition ensures sufficient milk supply and maternal health, making this the correct teaching.

Choice B reason: Avoiding seafood entirely is unnecessary. While certain fish high in mercury should be limited, many types of seafood are safe and provide beneficial omega-3 fatty acids. Blanket avoidance is not evidence-based.

Choice C reason: Waiting 1 hour after consuming alcohol is not sufficient. Alcohol passes into breast milk, and the recommended guideline is to avoid alcohol altogether or wait at least 2–3 hours per drink before breastfeeding. Therefore, this statement is inaccurate.

Choice D reason: Caffeine does enter breast milk, but it does so quickly, not slowly. Moderate caffeine intake (about 200–300 mg/day) is generally safe, but excessive intake can cause irritability and poor sleep in infants. The statement is misleading and incorrect.

Choice A reason: Morphine is contraindicated in clients with absent bowel sounds because it can worsen or precipitate paralytic ileus. Opioids decrease gastrointestinal motility, and in the presence of absent bowel sounds, this could lead to severe complications such as bowel obstruction or perforation. This makes it the most urgent contraindication.

Choice B reason: A respiratory rate of 14/min is within the normal range (12–20 breaths per minute). Morphine can cause respiratory depression, but this finding does not indicate a contraindication at baseline. The nurse should monitor closely after administration, but it is safe to proceed.

Choice C reason: A blood pressure of 100/60 mm Hg is on the lower side but still acceptable. Morphine can cause vasodilation and hypotension, so caution is warranted, but this value alone does not contraindicate administration. Monitoring blood pressure after administration is appropriate.

Choice D reason: A urine output of 100 mL/hr is adequate and indicates normal renal function. Morphine is metabolized primarily in the liver and excreted by the kidneys, but this urine output does not suggest impairment.